Cranial Nerve Disorders Associated With Immune Checkpoint Inhibitors.

Area of Science:

• Neurology
• Immunology
• Oncology

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment.
• Cranial nerve disorders are a rare but significant neurotoxicity associated with ICIs.
• Understanding the spectrum and outcomes of these disorders is crucial for patient management.

Observation:

• A nationwide retrospective study and systematic literature review identified 67 cases of ICI-related neurologic toxicities, including 9 cases of cranial nerve involvement (Cn-ICI).
• The most commonly affected cranial nerves were facial, vestibulocochlear, optic, and abducens nerves.
• Treatment strategies included corticosteroids, ICI discontinuation, plasma exchange, and IV immunoglobulin.

Findings:

• Approximately one-third of patients with Cn-ICI experienced persistent neurologic deficits, primarily affecting vision and hearing.
• Facial and vestibulocochlear nerve involvement were most frequent in the combined literature and case series.
• Despite treatment, persistent deficits were observed in 33% of cases.

Implications:

• Cranial nerve disorders are a potential complication of ICI therapy that requires vigilant monitoring.
• Early recognition and appropriate management may help mitigate long-term sequelae.
• Further research is needed to elucidate the precise mechanisms and optimize treatment for Cn-ICI.