Immune checkpoint inhibitors-induced neuromuscular toxicity: From pathogenesis to treatment

Dimitri Psimaras, Roser Velasco, Cristina Birzu, Stefano Tamburin, Maryam Lustberg, Jordi Bruna, Andreas A. Argyriou

Research output: Contribution to journalReview articleResearchpeer-review

11 Citations (Scopus)

Abstract

© 2019 Peripheral Nerve Society Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PD-L1, and anti-CTLA-4 treatment, and include myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment. Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multi-disciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange, and other immune-modulating treatments should be considered in more severe cases. Consideration of re-challenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs.
Original languageEnglish
Pages (from-to)S74-S85
JournalJournal of the Peripheral Nervous System
Volume24
Issue numberS2
DOIs
Publication statusPublished - 1 Oct 2019

Keywords

  • CTLA-4
  • demyelinating polyradiculoneuropathy
  • immune checkpoint inhibitor
  • myasthenia gravis
  • myositis
  • nivolumab
  • PD-1
  • PD-L1
  • pembrolizumab
  • peripheral neuropathy

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