Journal Article Review Ppublish
PubMed: 39535217 DOI: 10.1093/neuonc/noae243
Immunotherapy-related neurotoxicity in the central nervous system of children with cancer.
Neuro Oncol 27(3):625-643
Authors: Jiasen He, Jeremy Connors, Andrew Meador, Shuo Xu, Heather Meador, Hong Jiang, Juan Fueyo, Candelaria Gomez-Manzano, Gregory K Friedman, Wafik Zaky, Zsila Sadighi, John M Slopis, Ali H Ahmad
Affiliations
- Section of Pediatric Neuro-Oncology, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
- Section of Stem Cell Transplant, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
- Texas A&M University School of Medicine, Bryan, Texas, USA.
- Section of Pediatric Hematology Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
- Section of Pediatric Critical Care, Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Abstract
Significant gaps remain in our understanding of immunotherapy-related neurotoxicity in pediatric patients, largely because much of our knowledge comes from studies in adults. Accurately identifying the adverse effects of immunotherapy in children is also challenging, owing to variations in terminology and grading systems. Moreover, the manifestation of immunotherapy-related neurotoxicity differs greatly across different diseases, various modalities, dosages, and delivery methods. Combining immunotherapy with other treatments might improve outcomes but introduces new complexities and potential for increased toxicities. Additionally, pediatric patients with intracranial malignancy have unique responses to immunotherapies and distinct neurotoxicity compared to those with extracranial malignancy. Consequently, we must enhance our understanding of the pathophysiology, prevalence, severity, and management of immunotherapy's neurotoxic effects in this vulnerable group. This review consolidates the current knowledge of immunotherapy-related neurotoxicity in pediatric oncology, highlighting various types of neurotoxicity including cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and tumor inflammation-associated neurotoxicity (TIAN), among others. Furthermore, we examine the unique features of neurotoxicity associated with adoptive cellular therapy (ACT), antibody-based therapies, immune checkpoint inhibitors (ICIs), oncolytic viruses (OV), and cancer vaccines.
MeSH
Brain Neoplasms, Cells, Neoplasms, Central Nervous System, Immunotherapy, Therapeutics, Nervous System, Child