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Risk of Neurological Toxicities Following the Use of Different Immune Checkpoint Inhibitor Regimens in Solid Tumors A Systematic Review and Meta-analysis

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单位: [1]Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China [2]Department of Neurology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China [3]Department of Oncology, Beijing Friendship Hospital of Capital Medical University, Beijing, China [4]Department of Biochemistry, McGill University [5]College Jean-de-Brebeuf, Montreal, Quebec, Canada.
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关键词: immune checkpoint inhibitors CTLA4 inhibitor PD-L1 inhibitor PD-1 inhibitor neurological toxicities immune-related adverse events peripheral neuropathy

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Objectives: The objective of this study was to assess risk of neurological toxicities following the use of different immune checkpoint inhibitor (ICI) regimens in solid tumors. Methods: Pubmed, Embase, and ClinicalTrials. gov databases were searched for publications, and data were analyzed using Review Manager 5.3 software to compare the risk of immune-related and nonspecific neurological complications potentially triggered by ICIs to controls. Results: In total 23 randomized clinical trials comprising 11,687 patients were included in this meta-analysis. Patients with PD-L1 (OR, 0.29; 95% confidence interval [CI], 0.18-0.48; P< 0.01) or programmed cell-death protein 1 (PD-1) inhibitor (OR, 0.21; 95% CI, 0.14-0.31; P< 0.01) were less likely to develop any-grade peripheral neuropathy than chemotherapy, while the risk of grade 3-5 was also smaller for PD1 inhibitor (OR, 0.16; 95% CI, 0.05-0.54; P= 0.003). Combination therapy with CTLA4 and PD-1 inhibitor did not significantly increase the risk of any-grade (OR, 0.83; 95% CI, 0.21-3.32; P> 0.05) or grade 3-5 (OR, 1.4; 95% CI, 0.2-9.61; P> 0.05) peripheral neuropathy compared to monotherapy with CTLA4 or PD-1 inhibitor. However, difference in risk of immune-related adverse events (irAEs) involving central nervous system did not reach statistical significance in patients with different ICI regimens compared those under chemotherapy. Additionally, risk of experiencing paresthesia was in line with that of peripheral neuropathy (OR, 0.42; 95% CI, 0.28-0.62; P< 0.01). Conclusions: This meta-analysis shows that PD-L1/PD-1 and CTLA4 inhibitor have decreased risk of peripheral neuropathy compared to chemotherapy, while combination therapy with CTLA4 and PD-1 inhibitor have no difference in neurological toxicities compared to monotherapy with CTLA4 or PD-1 inhibitor.

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出版当年[2018]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学
最新[2025]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学
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出版当年[2017]版:
Q4 CLINICAL NEUROLOGY
最新[2023]版:
Q4 CLINICAL NEUROLOGY

影响因子: 最新[2023版] 最新五年平均[2021-2025] 出版当年[2017版] 出版当年五年平均[2013-2017] 出版前一年[2016版] 出版后一年[2018版]

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第一作者单位: [1]Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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通讯机构: [3]Department of Oncology, Beijing Friendship Hospital of Capital Medical University, Beijing, China [*1]Department of Oncology, Beijing Friendship Hospital of Capital Medical University, Beijing, China
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