Evidence map›Paper›PMID 33660430›Full record

ArticleCancer medicine2021

Recognizing encephalopathy in immune checkpoint inhibitor therapy: A single-center experience.

Danmeng Wei, Daniel J Zhou, Proleta Datta, Olga Taraschenko

Open access · goldAbstract read
In one paragraph

Article in Cancer medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.4field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 1 institution in 1 country.

Danmeng WeiDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Daniel J ZhouDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Proleta DattaDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.
Olga TaraschenkoDepartment of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA.ORCID 0000-0003-4848-8909
University of Nebraska Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn this pilot study, we examined the characteristics of patients with and without central nervous system (CNS) malignancies who developed immune checkpoint inhibitor (ICI)-induced encephalopathy.

methodsWe identified adult patients treated with ICIs between 1 January 2013 and 9 May 2018 at our tertiary care center who developed encephalopathy within 30 days of the last dose of ICI without other explained causes. Demographic and clinical features were compared between patients with primary and metastatic malignant CNS tumors and those without.

resultsOf the 480 patients treated with ICIs, 14 (2.9%) developed encephalopathy induced by nivolumab (8), pembrolizumab (4), and combined ipilimumab-nivolumab (2). Median age was 64.5 years. Patients with CNS malignancies tolerated more treatment cycles and developed encephalopathy later than patients without CNS lesions (20 and 32 days, respectively, p = 0.04) following ICI initiation. Four of seven patients with CNS tumors developed new contrast-enhancing lesions on brain imaging despite having no changes on imaging for a median of 61 (30-545) days. Electroencephalogram (EEG) revealed features of generalized dysfunction in patients in both cohorts. Two patients without and three with CNS malignancies were treated with steroids. Two thirds of patients without and 29% of those with CNS malignancies expired during ICI therapy or shortly thereafter.

conclusionsLack of the uniform evaluation limits the definitive conclusion of the cause of encephalopathy in some patients but reflects the standard of care at the time of their assessment. ICI-associated neurotoxicity presenting with encephalopathy is an ominous complication of ICI therapy, especially if left untreated. Prompt recognition and involvement of multidisciplinary care, including neurologists, would facilitate timely administration of recommended therapies.

Indexed as

AgedAged, 80 and overAntibodies, MonoclonalAntibodies, Monoclonal, HumanizedBrain DiseasesCentral Nervous System NeoplasmsDrug CombinationsFemaleHumansImmune Checkpoint InhibitorsIpilimumabMaleMiddle AgedNivolumabPilot ProjectsRetrospective StudiesAntibodies, MonoclonalAntibodies, Monoclonal, HumanizedatezolizumabavelumabDrug CombinationsdurvalumabImmune Checkpoint InhibitorsIpilimumabNivolumabpembrolizumabaltered mental statusencephalopathyimmune checkpoint blockadeimmunotherapy for cancerneurotoxicity

Identifiers

PMID33660430
PMCPMC8085930
OpenAlexW3134641391

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.