Immune checkpoint inhibitor neurotoxicity clinic: a service evaluation

<h3></h3> Immune checkpoint inhibitors (ICIs) are a form of cancer immunotherapy which have revolutionised the treatment and outcome of multiple solid organ malignancies [1], their use is continuing to expand. We have established a tertiary service specifically for seeing patients with suspected neurological toxicity secondary to ICIs. Here we report our findings. Between 2019 and 2023, 100 patients were seen within our service. The median time from referral by the oncologist to being seen in clinic was 10.5 days [IQR: 5 to 35 days], compared to median outpatient waiting times in London trust of 84- 154 days [2] and 32 weeks for General Neurology in NHNN/UCLH. Of the 32/100 with ICI-neurotoxicity the median time from referral to diagnosis was 25 days [6 to 64 days]. All patients were treated with steroids, and the majority were commenced on steroids prior to assessment by a neurologist. Additional treatments by neurologists included IVIG (6 patients), plasma exchange (4 patients) and steroid-sparing agents (4 patients). The median mRS at 6 months 1 [1 to 3]. This novel, responsive and patient-centred model for neurological immune- related toxicity has a positive impact on patient outcome which is reported as 30- 50% mortality in the literature.