Episode 64 - Neurologic Complications of Systemic Cancer Therapies
Feb 1, 2024
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Exploring neurological complications of systemic cancer therapies, including chemotherapy-induced neurotoxicity, immune checkpoint inhibitors, and CAR-T cell therapy. Discussion on monitoring and managing neurotoxicity post-treatment, immune reconstitution inflammatory syndrome, and challenges in treating complications.
Leptomeningeal metastases are increasing due to better cancer therapies, challenging diagnosis and treatment.
Paraneoplastic syndromes require collaboration between neurology and oncology specialists for effective management.
Deep dives
Direct Complications of Cancer: Metastases to the Brain and Spinal Cord
Cancer metastasizing elsewhere in the body can affect the nervous system, leading to symptoms like seizures. Leptomeningeal metastases, where cancer spreads to the spinal fluid space, are becoming more common as patients live longer due to better therapies, posing challenges in diagnosis and treatment.
Indirect Neurologic Complications: Response to Cancer
The body's response to cancer can indirectly cause neurologic symptoms, known as paraneoplastic syndromes. These syndromes can overlap with neuroimmunology, requiring the expertise of both specialties to address them effectively.
Treatment-Related Neurologic Complications: Chemotherapy and Radiation Effects
Chemotherapy and radiation treatments can lead to peripheral nervous system issues like neuropathy, and central nervous system complications such as encephalopathy and leucoencephalopathy. Specific chemotherapy agents like platinum compounds and taxanes are known to induce neuropathy.
Treatment-Related Neurologic Complications: CAR T Cell Therapy and Immune Checkpoint Inhibitors
CAR T cell therapy can trigger neurotoxicity symptoms within days to weeks after administration, requiring close monitoring and early intervention with steroids to manage symptoms. Similarly, immune checkpoint inhibitors can lead to a range of neurologic syndromes, from peripheral neuropathies to central nervous system complications, necessitating prompt recognition and treatment.
A discussion of the neurological complications of systemic cancer treatments, with Drs. Kevin Yan and Mary Barden.
Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.
Further Reading: Taylor JW. Neurologic Complications of Conventional Chemotherapy and Radiation Therapy. Continuum (Minneap Minn). 2023 Dec 1;29(6):1809-1826. doi: 10.1212/CON.0000000000001358. PMID: 38085899. Wang N. Neurologic Complications of Cancer Immunotherapy. Continuum (Minneap Minn). 2023 Dec 1;29(6):1827-1843. doi: 10.1212/CON.0000000000001362. PMID: 38085900.
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