Case Report: Neurological immune-related adverse events with anti-PD-1 based immunotherapy in cervical cancer

Despite recent advances in screening and primary prevention, cervical cancer (CC) still represents the fourth leading cancer in terms of incidence and mortality among women. Immune checkpoint inhibitors (ICIs) have gradually emerged as a promising treatment option in the management of CC. However, their use is associated with immune-related adverse events (irAEs), which may occur up to several months after starting or ending therapy. Although irAEs can potentially affect any organs or systems, some sites, such as the nervous system, are seldom involved. We report on the case of a 54-year-old patient with HPV-related, recurrent and metastatic CC treated with cemiplimab. Following an initial favourable partial response, the treatment had to be interrupted due to the onset of immune-related pneumonitis. Subsequently, during steroid tapering, the patient developed myositis and myelitis requiring hospitalization. Further investigations including cerebrospinal fluid analysis, serologic testing, virological and microbiological studies, and radiological imaging excluded infectious, malignant and primary inflammatory neurological aetiologies, supporting the hypothesis of a delayed irAE. Despite immunosuppressive treatment with high-dose steroids and a course of plasmapheresis, the patient gained only partial clinical improvement, requiring a rehabilitation treatment in a specialised facility. The widespread use of immunotherapy in advanced-stage malignancies is expected to increase the incidence of irAEs, including rare and severe forms such as neurological events and those with delayed onset. Consequentially, structured and prolonged follow-up is essential for early identification and effective management of ICIs toxicities.