Neurologic complications of cancer treatment with biologic agents
- Eudocia Quant Lee, MD, MPH
Eudocia Quant Lee, MD, MPH
- Assistant Professor of Neurology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
Neurologic complications of anticancer therapy may result from direct toxic effects on the nervous system, or indirectly from drug-induced metabolic derangements or cerebrovascular disorders, or, in the case of ipilimumab, autoimmune disorders. Their recognition is important because of potential confusion with metastatic disease, paraneoplastic syndromes or comorbid neurologic disorders that do not require dose reduction or discontinuation. If the neurologic disorder is caused by the chemotherapy, discontinuation of the offending agent may prevent irreversible injury.
Here we discuss the neurologic complications associated with biologic agents, including both biological response modifiers and monoclonal antibodies. The neurological complications associated with cytotoxic chemotherapy agents are discussed elsewhere. (See "Overview of neurologic complications of non-platinum cancer chemotherapy" and "Overview of neurologic complications of platinum-based chemotherapy".)
BIOLOGICAL RESPONSE MODIFIERS
In more recent years there has been increasing interest in the use of biological response modifiers in cancer treatment. Frequently, they are used in combination with conventional chemotherapeutic agents (biochemotherapy).
Interferon — Interferon alpha (IFN-a) is useful for a number of cancers including hairy cell leukemia, Kaposi's sarcoma, melanoma, multiple myeloma, chronic myeloid leukemia (CML), and low-grade lymphoma. However, IFN-a is associated with a variety of substantial toxicities, which may limit the ability to deliver a full course of therapy . Frequent systemic toxicities include flu-like symptoms (myalgias, nausea, vomiting, arthralgias, fever, chills, and headache) and depression. The flu-like symptoms tend to be worse at the onset of therapy and usually improve with time.
Neurotoxicity tends to be dose-related. It is generally mild when low doses of IFN-a are used, as in the adjuvant setting for patients with malignant melanoma. In a detailed evaluation of 37 such patients treated with IFN, the most frequent neurotoxicity was tremor, observed in eight cases (22 percent) . (See "Adjuvant immunotherapy for melanoma", section on 'Interferon alfa'.)
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- BIOLOGICAL RESPONSE MODIFIERS
- - Interferon alfa-2a (Roferon, Pegasys)
- - Interferon alfa-2b (Intron, PEG-Intron)
- - Intrathecal interferon
- Beta and gamma interferon
- Tumor necrosis factor
- MONOCLONAL ANTIBODIES
- Tositumomab radioconjugate
- - Ado-trastuzumab emtansine