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Neuromuscular Complications of Programmed Cell Death-1 (PD-1) Inhibitors
Justin C Kao1, Adipong Brickshawana2, Teerin Liewluck3
1Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
Purpose Of Review:
In recent years, immune checkpoint inhibitors have been increasingly used in patients with metastatic cancers with favorable oncological outcomes; however, there have also been increasing number of cancer survivors who have developed immune-related adverse events. Little is known about PD-1 inhibitor-associated neuromuscular complications.
Recent Findings:
Neuromuscular disorders are the most common neurological complication reported in PD-1 inhibitor-treated patients. Myasthenia gravis, immune-mediated myopathies, and Guillain-Barre syndrome are among commonly reported immune-related neuromuscular complications. HyperCKemia occurs frequently in patients with PD-1 inhibitor-associated myasthenia gravis, indicating coexisting myopathies or myocarditis. Oculobulbar weakness is a unique and common presentation of PD-1 inhibitor-associated immune-mediated myopathies with or without concomitant myasthenia gravis. High-dose steroid monotherapy may be associated with clinical deterioration in some patients with PD-1 inhibitor-associated myasthenia gravis, immune-mediated myopathies, or Guillain-Barre syndrome. PD-1 inhibitor-associated neuromuscular complications have some characteristic features compared to their idiopathic counterparts. Although steroid monotherapy is commonly used in non-neuromuscular autoimmune disorders triggered by anti-PD-1 therapy, this may lead to unfavorable outcomes in some patients with PD-1 inhibitor-associated neuromuscular complications.
Insights
Immune checkpoint inhibitors can cause neuromuscular complications like myasthenia gravis. High-dose steroids may worsen outcomes for these PD-1 inhibitor-associated disorders.
Area of Science:
- Oncology
- Neurology
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) improve metastatic cancer outcomes.
- Cancer survivors increasingly experience immune-related adverse events.
- PD-1 inhibitor-associated neuromuscular complications are not well understood.
Purpose of the Study:
- To review the characteristics of PD-1 inhibitor-associated neuromuscular complications.
- To highlight differences from idiopathic neuromuscular disorders.
- To discuss treatment implications.
Main Methods:
- Review of recent literature on PD-1 inhibitor-induced neuromuscular disorders.
- Analysis of reported cases and clinical presentations.
- Comparison with idiopathic counterparts.
Main Results:
- Neuromuscular disorders are common neurological complications of PD-1 inhibitors.
- Myasthenia gravis, myopathies, and Guillain-Barre syndrome are frequent.
- HyperCKemia and oculobulbar weakness are notable findings.
- Steroid monotherapy may lead to deterioration in some cases.
Conclusions:
- PD-1 inhibitor-associated neuromuscular complications have distinct features.
- Standard high-dose steroid monotherapy may be detrimental for certain ICI-induced neuromuscular conditions.
- Further research is needed for optimal management strategies.
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