National immunotherapy-neurotoxicity service : University College London Hospitals NHS Foundation Trust

The UCLH immunotherapy-neurotoxicity multidisciplinary service (IO-neurotox MDT) offer high-quality diagnostic and management guidance on the care of cancer patients with, or suspected of having, any form of neurological complication of immunotherapy (immune-checkpoint inhibitor therapy).

The service was established collaboratively between the National Hospital for Neurology and Neurosurgery (NHNN) and a nationwide oncology clinical team

We provide multidisciplinary care for patients who have been referred by their GP or from other hospitals. Although immune-related neurotoxicity is relatively rare, it may be severe and is associated with significant disability and high risk to patients if not recognised and managed promptly and well.

Triple M syndrome (myasthenia, myositis and myocarditis)
Immune-checkpoint inhibitor-related neuritis (ICI-neuritis)
ICI-myositis
ICI-myasthenia
ICI-encephalitis
ICI-aseptic meningitis
ICI-vestibulitis
ICI-ADEM
Or any other immune-related neurological manifestation of immunotherapy

All conditions are supported by two clinical nurse specialists:

an oncology based IO-toxicity clinical nurse specialist with expertise in cancer and cancer therapy
a neurology clinical nurse specialist with expertise in immunosuppression and its safety monitoring

There is also a Macmillan Advice Centre within the Outpatient Building providing support and advice on cancer-related conditions to patients and relatives.

Patient aftercare is dependent on the nature of the condition. Some patients will be suitable to be managed in the community by their GP, some will require ongoing hospital visits, typically with their referring oncology team or with local neurology input if required, and some will be discharged after treatment.