[Neuromuscular Adverse Events]

Area of Science:

• Oncology
• Neurology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) are revolutionary cancer therapies.
• Neuromuscular adverse events (AEs) are infrequent but serious complications of ICI treatment.
• The diverse clinical presentations and underlying mechanisms of ICI-related neuromuscular AEs require elucidation.

Purpose of the Study:

• To summarize the general features of neuromuscular AEs associated with ICIs.
• To highlight the spectrum of central nervous system, peripheral nerve, neuromuscular junction, and muscle involvement.
• To emphasize the importance of early diagnosis and management strategies for these AEs.

Main Methods:

• Review of clinical presentations and characteristics of neuromuscular AEs in cancer patients treated with ICIs.
• Analysis of the frequency, affected systems, and clinical course of these events.
• Discussion of the role of CD8+ cytotoxic T-cells and autoantibodies in pathogenesis.

Main Results:

• Neuromuscular AEs affect 1-2% of patients on ICIs, involving diverse neurological systems.
• Common mild AEs include headache, dizziness, and dysgeusia.
• Serious AEs include autoimmune encephalitis, demyelinating polyneuropathy, myasthenia gravis, and myositis, often associated with myocarditis.

Conclusions:

• Neuromuscular AEs from ICIs can have rapid onset and critical courses, differing from non-drug-related conditions.
• Withholding ICI therapy is recommended for significant neurological symptoms until diagnosis.
• Immune-modulating therapies are generally effective, and understanding pathogenesis is key for optimal patient management.