Welcome to the WCN 2021 Interactive Program
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Please note that all sessions will run at their scheduled time and be followed by a LIVE Q&A/Discussion at the end
The viewing of sessions, cannot be accessed from this conference calendar. All sessions are accessible via the Virtual Platform
- Riccardo Soffietti (Italy)
BRAIN METASTASES
- Riccardo Soffietti (Italy)
Abstract
Abstract Body
Brain metastases (BM) from solid tumors are increasing in incidence due to an early use of MRI for diagnosis and improvement of outcome of some molecular subgroups following targeted agents and immunotherapy. Surgical resection is a treatment of choice for solitary brain metastases in an accessible location and with a diameter ≥ 3 cm. Stereotactic radiosurgery may be indicated for single or multiple brain metastases, while whole-brain radiotherapy is reversed for palliation of symptoms only. EGFR or ALK inhibitors have allowed in BM from NSCLC a prolongation of median survival up to 3-4 years. BRAF inhibitors have dramatically improved the prognosis of BM from melanoma, and the same is true for immunotherapy. BM from HER2+ positive breast cancer may be treated either by small tyrosine kinase inhibitors or monoclonal antibodies. The monitoring of response and early tumor progression by neuroimaging and liquid biopsy are key issues for both clinical trials and daily practice.
COMPLICATIONS OF CANCER THERAPIES INCLUDING IMMUNOTHERAPIES
- Amy Pruitt (United States of America)
Abstract
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The past 5 years have witnessed an explosion of treatments that harness the power of the host's immune system to treat various systemic cancers . These treatments have dramatically altered the prognosis for cerebral metastases from non-small cell lung cancer and melanoma, among others. At the same time chimeric antigen receptor therapy (CAR T therapy has effectively treated B cell lymphomas and several types of leukemia. Each of these therapies has introduced, however, a number of new neurological complications involving both the central (CNS) and peripheral nervous systems (PNS) and neurologic consultants' diagnostic acumen is challenged to recognize and mitigate these complications as well as to help oncologists decide if these therapies can be continued. This discussion will briefly review the neurological complications of conventional cytotoxic therapies and then, through a series of case-based examples, discuss CNS complications ranging from hypophysitis to encephalitis and cerebellitis and PNS complications resulting in myasthenia, myocarditis, myositis, and autoimmune neuropahties. We will discuss particular issues involving these therapies in patients with pre-existing neurological conidtions such as multiple sclerosis. We will cover the acute management of CAR T complications including cytokine release syndrome and CAR T -related encephalopathy syndrome (CRES) . We will discuss the less encouraging results of immunotherapies for primary brain tumors.
PARANEOPLASTIC SYNDROMES
- Sith Sathornsumetee (Thailand)
Abstract
Abstract Body
Paraneoplastic neurological disorders (PNDs) comprise a variety of non-metastatic nervous system dysfunctions derived from systemic cancer. Pathogenesis of PND is likely an immune-mediated process secondary to anti-tumor immune response against antigen shared between cancer and nervous system. Clinical features suggesting PNDs may include subacute onset of rapidly progressive, focal or multifocal, central and/or peripheral, neurological dysfunction in otherwise healthy patients who are not known to have cancer. Neuroimaging findings are variable ranging from normal to abnormal signal in specific pattern, whereas CSF often demonstrates mild lymphocytic pleocytosis with slight elevation of protein in an early course of PND affecting central nervous system. Classic PNDs are defined by the presence of onconeural antibody in serum and/or CSF that leads to the search for cancer, which is usually in limited stage. Recent identification of several autoantibodies against neuronal surface or synapse has expanded the spectrum of autoimmune encephalopathy. However, the rate of cancer detection for this group of disorders is variable. Emerging use of immune checkpoint inhibitor (ICB) for cancer therapy may precipitate PND in addition to its known neurological immune-related adverse event. Treatment of PNDs includes tumor-directed therapy and early immunosuppression. ICB should be discontinued in PND associated with ICB. Immunotherapy such as corticosteroids, intravenous immune globulin, plasma exchange or rituximab is frequently effective in PNDs with antibody/complement-mediated neuronal dysfunction. However, immunosuppressive therapy is often not helpful for classic PNDs with cell-mediated toxicity against intracellular neuronal antigens.