Safety of Cancer Treatments in Patients With Multiple Sclerosis: Prashanth Rajarajan, MD, PhD

WATCH TIME: 6 minutes

"The checkpoint inhibitors seem to be safe from the perspective of not exacerbating the underlying neurologic condition."

Research shows an association between the use of immune checkpoint inhibitors (ICIs) and immune-related adverse events (irAEs) as well as exacerbation of pre-existing autoimmune diseases. Although prior studies show that ICIs trigger relapses in patients with multiple sclerosis (MS), the incidence of ICI-induced MS activity is unclear. In a new interim analysis of a study of patients with MS who were predominantly older and not on disease-modifying therapy (DMT), findings showed an unusual occurrence of MS relapses and disease progression following ICI treatment.¹

Investigators identified 38 patients with MS who were treated with ICIs, 13 (34%) of whom were on DMT immediately prior to ICI initiation and 8 who continued on DMT during ICI therapy. Presented at the 2024 American Academy of Neurology (AAN) Annual Meeting, held April 13-18, in Denver, Colorado, by coauthor Prashanth Rajarajan, MD, PhD, and colleagues, the most common primary tumors were lung (n = 11) and melanoma (n = 10). Over a mean follow-up of 13 months after ICI initiation, 1 patient had a relapse after ICI treatment and 1 other patient had ongoing progressive disease. Notably, 2 patients (5%) had peripheral nervous system ICI irAEs and 12 (32%) had a nonneurologic ICI irAEs.

Rajarajan, neurology resident at Massachusetts General Brigham, sat down with NeurologyLive^® at the meeting to further discuss how the use of immune checkpoint inhibitors impact patients with pre-existing MS. He also talked about the rates of relapse or disease activity that occur in MS patients treated with checkpoint inhibitors. In addition, Rajarajan spoke about how the treatment approach should differ for patients with MS as opposed to other autoimmune conditions.

Click here for more coverage of AAN 2024.

REFERENCES
1. Quinn C, Rajarajan P, Kopinsky H. Multi-institutional Study of Neurologic Outcomes in People with Multiple Sclerosis Who Are Treated with Immune Checkpoint Inhibitors for Oncologic Indications. Presented at: 2024 AAN Annual Meeting; April 13-18; Denver, CO.