Immune-Related Polyradiculoneuropathy Associated With Immune Checkpoint Inhibitors: A Comprehensive Case Series

Immune-related polyradiculoneuropathy (irPRN) is a rare but potentially severe neurological adverse event secondary to immune checkpoint inhibitors (ICIs), closely resembling Guillain-Barré syndrome. This study aims to characterize the clinical presentation, neurophysiological findings, therapeutic strategies, and clinical outcomes of patients diagnosed with irPRN.

We conducted a retrospective single-center study including patients diagnosed with irPRN following ICI therapy between May 2018 and July 2024. Clinical, electrophysiological, and cerebrospinal fluid (CSF) data were analyzed.

Nine patients (mean age 67.9 years; 66.7% male) developed immune-related polyradiculoneuropathy (irPRN), with a median onset of 6 weeks following initiation of immune checkpoint inhibitors (ICIs). Most cases (66.7%) occurred in patients receiving anti-PD-1 monotherapy. The clinical presentation was characterized by symmetric limb weakness (100%) and sensory disturbances (88.9%). Electrodiagnostic studies demonstrated a demyelinating polyradiculoneuropathy in 8 of 9 patients; only one exhibited an axonal pattern. CSF analysis revealed elevated protein levels in all tested patients, with mild pleocytosis in 62.5%. At nadir, the modified Rankin Scale (mRS) ranged from 3 to 5. Immunomodulatory therapy was administered in 8 of 9 patients (88.9%), leading to notable functional improvement (mRS 1-2) in five cases. ICI rechallenge was attempted in two patients, neither of whom experienced recurrence. No deaths were directly attributed to irPRN.

IrPRN is a rare but distinct complication of ICI therapy, typically presenting with a demyelinating neurophysiological pattern and favorable response to immunotherapy. Early recognition and treatment are critical to improving functional outcomes. Rechallenge may be feasible in selected cases without recurrence.