Immune mediated neuropathy following checkpoint immunotherapy

Area of Science:

• Neuroimmunology
• Oncology
• Neurology

Background:

• Checkpoint immunotherapy, including ipilimumab and nivolumab, is a standard treatment for metastatic melanoma.
• Acute inflammatory neuropathies are an uncommon but severe complication of this therapy.
• Previous cases were described individually, lacking group characterization.

Observation:

• A case of acute sensorimotor and autonomic neuropathy after combination ipilimumab and nivolumab therapy was identified.
• A literature review found 14 additional cases of immunotherapy-induced acute neuropathy.
• The majority presented as acute sensorimotor neuropathy with hyporeflexia, occurring weeks after treatment.

Findings:

• Immunotherapy-induced neuropathies differ from Guillain-Barre syndrome in cerebrospinal fluid (CSF) analysis (often lymphocytic) and electrophysiology (frequently axonal).
• Most patients (92%) experienced sensorimotor neuropathy with hyporeflexia.
• Steroid therapy was associated with a lower mortality rate compared to cases without steroids.

Implications:

• Checkpoint immunotherapy-induced acute neuropathies represent a distinct clinical entity.
• Prompt initiation of corticosteroid therapy is recommended for these adverse events.
• Further research into managing immunotherapy-related neurological complications is warranted.