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Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors

Background and Objectives: Immune checkpoint inhibitors (ICIs) have enriched tumor therapy, improving overall survival. Immunotherapy adverse events (irAEs) occur in up to 50% of patients and also affect the peripheral nervous system. The exact pathomechanism is unclear; however, an autoimmune proce...

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Autores principales: Kneer, Katharina, Stahl, Jan-Hendrik, Kronlage, Cornelius, Bombach, Paula, Renovanz, Mirjam, Winter, Natalie, Grimm, Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10302462/
https://www.ncbi.nlm.nih.gov/pubmed/37374207
http://dx.doi.org/10.3390/medicina59061003
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author Kneer, Katharina
Stahl, Jan-Hendrik
Kronlage, Cornelius
Bombach, Paula
Renovanz, Mirjam
Winter, Natalie
Grimm, Alexander
author_facet Kneer, Katharina
Stahl, Jan-Hendrik
Kronlage, Cornelius
Bombach, Paula
Renovanz, Mirjam
Winter, Natalie
Grimm, Alexander
author_sort Kneer, Katharina
collection PubMed
description Background and Objectives: Immune checkpoint inhibitors (ICIs) have enriched tumor therapy, improving overall survival. Immunotherapy adverse events (irAEs) occur in up to 50% of patients and also affect the peripheral nervous system. The exact pathomechanism is unclear; however, an autoimmune process is implicated. Thus, the clinical evaluation of irAEs in the peripheral nervous system is still demanding. We retrospectively analyzed nerve ultrasound (NU) data of polyneuropathies (PNPs) secondary to checkpoint inhibitors. Materials and Methods: NU data of patients with PNP symptoms secondary to ICI therapy were retrospectively analyzed using the Ultrasound Pattern Sum Score (UPSS) as a quantitative marker. Our findings were compared with a propensity score match analysis (1:1 ratio) to NU findings in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and chemotherapy-associated PNP patients. Results: In total, 10 patients were included (4 female, mean age 66 ± 10.5, IQR 60–77), where NU was performed in 80%. The UPSS obtained ranged from 0 to 5 (mean 2 ± 1.6, IQR 1–2.5). The morphological changes seen in the NUs resembled sonographic changes seen in chemotherapy-associated PNP (n = 10, mean UPSS 1 ± 1, IQR 0–2) with little to no nerve swelling. In contrast, CIDP patients had a significantly higher UPSS (n = 10, mean UPSS 11 ± 4, IQR 8–13, p < 0.0001). Conclusions: Although an autoimmune process is hypothesized to cause peripheral neurological irAEs, NU showed no increased swelling as seen in CIDP. The nerve swelling observed was mild and comparable to ultrasound findings seen in chemotherapy-associated PNP.
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spelling pubmed-103024622023-06-29 Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors Kneer, Katharina Stahl, Jan-Hendrik Kronlage, Cornelius Bombach, Paula Renovanz, Mirjam Winter, Natalie Grimm, Alexander Medicina (Kaunas) Article Background and Objectives: Immune checkpoint inhibitors (ICIs) have enriched tumor therapy, improving overall survival. Immunotherapy adverse events (irAEs) occur in up to 50% of patients and also affect the peripheral nervous system. The exact pathomechanism is unclear; however, an autoimmune process is implicated. Thus, the clinical evaluation of irAEs in the peripheral nervous system is still demanding. We retrospectively analyzed nerve ultrasound (NU) data of polyneuropathies (PNPs) secondary to checkpoint inhibitors. Materials and Methods: NU data of patients with PNP symptoms secondary to ICI therapy were retrospectively analyzed using the Ultrasound Pattern Sum Score (UPSS) as a quantitative marker. Our findings were compared with a propensity score match analysis (1:1 ratio) to NU findings in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and chemotherapy-associated PNP patients. Results: In total, 10 patients were included (4 female, mean age 66 ± 10.5, IQR 60–77), where NU was performed in 80%. The UPSS obtained ranged from 0 to 5 (mean 2 ± 1.6, IQR 1–2.5). The morphological changes seen in the NUs resembled sonographic changes seen in chemotherapy-associated PNP (n = 10, mean UPSS 1 ± 1, IQR 0–2) with little to no nerve swelling. In contrast, CIDP patients had a significantly higher UPSS (n = 10, mean UPSS 11 ± 4, IQR 8–13, p < 0.0001). Conclusions: Although an autoimmune process is hypothesized to cause peripheral neurological irAEs, NU showed no increased swelling as seen in CIDP. The nerve swelling observed was mild and comparable to ultrasound findings seen in chemotherapy-associated PNP. MDPI 2023-05-23 /pmc/articles/PMC10302462/ /pubmed/37374207 http://dx.doi.org/10.3390/medicina59061003 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kneer, Katharina
Stahl, Jan-Hendrik
Kronlage, Cornelius
Bombach, Paula
Renovanz, Mirjam
Winter, Natalie
Grimm, Alexander
Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title_full Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title_fullStr Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title_full_unstemmed Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title_short Nerve Ultrasound of Peripheral Nerves in Patients Treated with Immune Checkpoint Inhibitors
title_sort nerve ultrasound of peripheral nerves in patients treated with immune checkpoint inhibitors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10302462/
https://www.ncbi.nlm.nih.gov/pubmed/37374207
http://dx.doi.org/10.3390/medicina59061003
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