[Immune Checkpoint Inhibitors and Neuromuscular Adverse Events]

Area of Science:

• Neuroimmunology
• Oncology
• Pharmacology

Background:

• Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies.
• Neuromuscular adverse events (AEs) are rare complications of ICI therapy, affecting 1-2% of patients.
• These AEs can impact the central nervous system, peripheral nerves, neuromuscular junction, and muscles, often with rapid onset.

Purpose of the Study:

• To elucidate the diverse clinical presentations and underlying mechanisms of neuromuscular AEs in cancer patients treated with ICIs.
• To highlight the correlation between ICIs and specific serious conditions like myasthenia, myositis, and myocarditis.
• To emphasize the need for understanding pathophysiology for effective management.

Main Methods:

• Review of clinical presentations of neuromuscular AEs.
• Analysis of the association between ICIs and specific neuromuscular conditions.
• Discussion of the immunological pathways involved in AE pathogenesis.

Main Results:

• Neuromuscular AEs present with diverse clinical subsets, affecting various parts of the neuromuscular system.
• While mild AEs like headache occur, serious immune-related AEs include autoimmune encephalitis, demyelinating polyneuropathy, myasthenia, and myositis.
• A strong correlation exists between ICIs and myasthenia, myositis, and myocarditis.

Conclusions:

• Neuromuscular AEs associated with ICIs require careful monitoring and prompt management.
• Immune-modulating therapies are generally effective, but treatment should be guided by defined pathophysiology.
• Both CD8+ cytotoxic T cells and autoantibodies play a role in the pathogenesis of these AEs.