Multinational retrospective study of immune checkpoint inhibitors in patients with solid tumors and paraneoplastic syndromes

Patients with paraneoplastic syndromes (PNS) are excluded from clinical trials involving immune checkpoint inhibitors (ICIs) due to safety concerns. Real-world data on efficacy and safety of ICIs in PNS patients are scarce. A retrospective study at nine centers included patients with solid tumors and PNS receiving ICIs. Exacerbations of pre-existing PNS occurred in 29% of patients. Treatment-related adverse events occurred in 39% of patients, and grade 3 or higher TRAEs occurred in 17%. Eighteen patients with PNS receiving ICIs for mNSCLC were matched with 40 non-PNS patients receiving ICIs for mNSCLC. There were no significant differences between the groups in overall survival or time to next treatment, although a trend was seen towards worse outcomes in patients with PNS. TRAEs and grade 3 or higher TRAEs also were similar between the groups. The authors conclude that pre-existing PNS should not preclude consideration of ICI therapy.