APHON Pediatric Chemotherapy-Biotherapy Renewal

Pembrolizumab Ipilimumab

Cranial nerve neuropathies

Nivolumab Pembrolizumab Nivolumab + ipilimumab Nivolumab Pembrolizumab Nivolumab + ipilimumab Ipilimumab Nivolumab Pembrolizumab Nivolumab + ipilimumab

Chronic immune demyelinating polyneuropathy

Encephalitis

Myasthenic syndromes

Myositis Ipilimumab Nivolumab Pembrolizumab Nivolumab + ipilimumab Data from “Neurological Toxicities Associated with Immune-Checkpoint Inhibitors,” by M. Touat, D, Talmasov, D. Ricard, and D. Psimaras, 2017, Current Opinion in Neurology , 30 (6), table 3. https://doi.org/10.1097/WCO.0000000000000503. Encephalitis is typically characterized by seizure, confusion ataxia, abnormal behavior, and alterations in levels of consciousness. Aseptic meningitis often presents with fever and headache and can occur anywhere from 1 to 7 weeks after initiation of the ICPI. Myasthenia gravis and necrotizing myositis often present within 2 to 6 weeks of initiating treatment with ICPIs. Myasthenia gravis presents with acute motor symptoms, fatigue, diplopia, respiratory insufficiency, and distal weakness (Becuart et al., 2019). If not recognized and treated appropriately, this disease can become quite serious and lead to death. Necrotizing myositis closely resembles myasthenia gravis because the clinical presentation is quite similar. Patients with necrotizing myositis may experience bilateral proximal limb muscle weakness, myalgia, fever, dyspnea, ptosis, ophthalmoparesis, and bulbar weakness (Touat et al., 2017). Cranial nerve palsies may involve the optic nerve, abducens, and facial nerves. Immune demyelinating polyradiculoneuropathy is a rare but severe complication that may resemble Guillain-Barré syndrome; therefore, recognition of symptoms is important in making a proper diagnosis. Symptoms include paresthesias in the arms and legs, generalized weakening of the extremities bilaterally, loss of reflexes, loss of balance and altered gait, and loss of sensitivity to pinprick during neurologic exam.