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Updated: Jun 25, 2025
Nerve Excitability Assessment in Chemotherapy-induced Neurotoxicity
Published on: April 26, 2012
Immune checkpoint inhibitors and neurotoxicity: a focus on diagnosis and management for a multidisciplinary approach
Desirèe Speranza1, Mariacarmela Santarpia1, Francesco Luppino2
1Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy.
Introduction:
Although immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, the consequential over activation of the immune system is often complicated by adverse events that can affect several organs and systems, including the nervous system. The precise pathophysiology underlying neurological irAEs (n-irAEs) is not completely known. Around 3.8% of patients receiving anti-CTLA-4 agents, 6.1% of patients receiving anti-PD-1/PD-L1, and 12% of patients receiving combination therapies have n-irAEs. Most n-irAEs are low-grade, while severe toxicities have rarely been reported. in this article, we performed an updated literature search on immuno-related neurotoxicity on main medical research database, from February 2017 to December 2023.
Areas Covered:
We have also compared the latest national and international guidelines on n-irAEs management with each other in order to better define patient management.
Expert Opinion:
A multidisciplinary approach appears necessary in the management of oncological patients during immunotherapy. Therefore, in order to better manage these toxicities, we believe that it is essential to collaborate with neurologists specialized in the diagnosis and treatment of n-irAEs, and that a global neurological assessment, both central and peripheral, is necessary before starting immunotherapy, with regular reassessment during treatment.
Insights
Immune checkpoint inhibitors (ICIs) can cause neurological adverse events (n-irAEs). This review updates knowledge on neurotoxicity and compares management guidelines, emphasizing a multidisciplinary approach for patient care.
Area of Science:
- Oncology
- Neuroscience
- Immunology
Background:
- Immune checkpoint inhibitors (ICIs) have transformed cancer therapy but can cause immune-related adverse events (irAEs), including neurological irAEs (n-irAEs).
- The pathophysiology of n-irAEs is not fully understood, with reported incidence rates varying by agent and combination therapy.
- While most n-irAEs are low-grade, severe neurotoxicity can occur, necessitating careful management.
Purpose of the Study:
- To provide an updated literature review on neurotoxicity associated with ICIs.
- To compare current national and international guidelines for managing n-irAEs.
- To highlight the importance of a multidisciplinary approach in managing these toxicities.
Main Methods:
- Conducted an updated literature search on immuno-related neurotoxicity in major medical databases from February 2017 to December 2023.
- Compared the latest national and international guidelines for n-irAEs management.
Main Results:
- Incidence of n-irAEs: 3.8% for anti-CTLA-4, 6.1% for anti-PD-1/PD-L1, and 12% for combination therapies.
- Most reported n-irAEs are low-grade, with severe cases being rare.
- Significant variations exist in current management guidelines.
Conclusions:
- A multidisciplinary approach involving oncologists and neurologists is crucial for managing patients receiving immunotherapy.
- Pre-treatment neurological assessment and regular reassessment during therapy are essential for early detection and management of n-irAEs.
- Standardized guidelines and collaborative care are needed to optimize patient outcomes and mitigate neurotoxicity risks.
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