Patients With Melanoma Using PD-1 Inhibitors Have Increased Risk of Adverse Autoimmune Neurologic Complications

Patients with melanoma who are receiving PD-1 inhibitor therapies are at greater risk of experiencing immune-related neurologic adverse events, according to the results of a study presented at the American Association of Neurological Surgeons 2024 Annual Scientific Meeting in Chicago, Illinois.

“Melanoma accounts for 5% of new cancer cases in the US each year and has a 5-year survival rate of 93.5%, reflecting a decrease in mortality rates accompanying the arrival of several immunotherapies on the market,” the study’s author Nikita Das, BA, wrote.

The purpose of the study was to investigate the possible increased risk for adverse neurologic events in patients with melanoma who are receiving PD-1 immunotherapy. The incidence of neurologic side effects caused by using PD-1 inhibitors is estimated between 5% to 12%, according to the study, but the impact of these complications on treatment course and metastatic prognosis required further investigation.

Included in the retrospective study were adult patients with melanoma. The data used were taken from TriNetX, which is a research network of 60 US health care organizations. The study included three cohorts: (1) melanoma patients (n = 1,460,509) with no history of PD-1 in inhibitor therapy, (2) melanoma patients (n = 22,936) treated with pembrolizumab or nivolumab following their diagnosis, (3) cohorts using covariates, including gender, race, age, and history of nervous system disease or neurodevelopmental disorders (n = 22,936).

Patients who received PD-1 inhibitors exhibited a significantly increased risk of developing various diseases when compared with patients with melanoma with no history of PD-1 inhibitors. According to the results of the study, there was an increased risk of meningitis, encephalitis, demyelinating myopathy, peripheral nervous system neuropathy, neuromuscular junction disorders, and inflammatory myopathy. The risk of a central nervous system vasculitis in patients did not differ between the cohorts.

“This study [shows] that melanoma patients receiving PD-1 inhibitor therapies are at greater risk of experiencing immune-related neurologic adverse events than patients on other treatment regimens. These findings underscore the need for more specific drug delivery mechanisms of immunotherapy to cancerous cells in order to minimize adverse side effects,” the study’s author concluded.

Reference:
Das N. Adverse autoimmune neurologic complications following PD-1 immunotherapy for treatment of melanoma. Presented at: American Association of Neurological Surgeons Annual Scientific Meeting; May 3-6, 2024; Chicago, IL. https://annualmeeting.aans.org/