Concurrent CNS tumors and multiple sclerosis: retrospective single-center cohort study and lessons for the clinical management

Abstract

Introduction The concurrent presence of both central nervous system (CNS) tumors and multiple sclerosis (MS) poses various diagnostic and therapeutic pitfalls and makes the clinical management of such patients challenging. Methods In this retrospective, single-center cohort study, we searched our clinical databases (2006–2019) for patients with concurrent CNS tumors and MS and described their disease courses. Age at diagnosis of the respective disease and probabilities for MS disease activity events (DAEs) with vs. without prior tumor-specific therapy were tested pairwise using t-test for dependent samples and exact binomial test. Results N = 16 patients with concurrent CNS tumors and MS were identified. MS diagnosis preceded the CNS oncological diagnosis by an average of 9 years (p = 0.004). More DAEs occurred in patients without prior chemotherapy (83.3%) than in patients with prior chemotherapy (16.7%; p = 0.008). This effect did not reach significance for patients with prior radiation therapy/radiosurgery (66.7% vs. 33.3%, p = 0.238). The average interval between DAEs and the last documented lymphopenia was 32.25 weeks. Conclusions This study describes the clinical and demographic features of patients with concurrent CNS tumors and MS and suggests several practical approaches to their clinical management. Our findings suggest that adding a disease-modifying MS therapy to the regimen of patients treated with chemotherapy is necessary only if the patient suffers from a highly active, aggressive course of MS. In view of the lack of prospective trials, individual risk assessments should remain the foundation of the decision on MS treatment in concurrent CNS tumor diseases.

Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society

“…In a more recent retrospective study involving 16 PwMS treated for a CNS tumor, no association was found between the risk of MS inflammatory activity (clinical/radiological) and prior exposure to radiotherapy or radiosurgery. 177 Among these patients, 62% had undergone radiotherapy or radiosurgery. Although the occurrence of MS inflammatory activity appeared to be more frequent in patients who had received radiotherapy or radiosurgery than those who had not, this difference was not statistically significant (66.7% vs. 33.3%, p = 0.238).…”

“…In a more recent retrospective study involving 16 PwMS treated for a CNS tumor, no association was found between the risk of MS inflammatory activity (clinical/radiological) and prior exposure to radiotherapy or radiosurgery. 177 Among these patients, 62% had undergone radiotherapy or radiosurgery.…”

“…The study found that the recurrence of inflammatory activity, whether clinical or observed on MRI, was more frequent in patients who did not receive chemotherapy (83.3%) than in those who did (16.7%). 177 Endocrine therapy. After an extensive review of the literature on PubMed, no publication supporting an increased risk of worsening MS related to the use of endocrine therapy was found.…”

The crossroads of multiple sclerosis and cancer: Urgent call for clinical direction

“…Upon reviewing the literature, we found only two recent retrospective studies. 4,5 The first, focused on the clinical course of MS in patients with breast cancer and their experiences dealing with both conditions. 4 Authors highlighted concerns raised by neurologists and oncologists regarding the concurrent use of immunosuppressive and anticancer therapies.…”

“…The other study, 5 described the clinical course of 16 patients with central nervous system (CNS) tumours and MS. They reported that 25% patients discontinued the MS treatment after oncological diagnosis and 31% never initiated it.…”