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Immune checkpoint inhibitors-induced neuromuscular toxicity: From pathogenesis to treatment.

  • Psimaras, Dimitri1, 2, 3
  • Velasco, Roser4, 5, 6
  • Birzu, Cristina1, 2, 3
  • Tamburin, Stefano7
  • Lustberg, Maryam8
  • Bruna, Jordi4, 5, 6
  • Argyriou, Andreas A9
  • 1 AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Service de Neurologie Mazarin, Paris, France. , (France)
  • 2 Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France. , (France)
  • 3 OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France. , (France)
  • 4 Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, IDIBELL, Barcelona, Spain. , (Spain)
  • 5 Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, Barcelona, Spain. , (Spain)
  • 6 Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain. , (Spain)
  • 7 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy. , (Italy)
  • 8 Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer, Columbus, Ohio.
  • 9 Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece. , (Greece)
Published Article
Journal of the peripheral nervous system : JPNS
Publication Date
Oct 01, 2019
24 Suppl 2
DOI: 10.1111/jns.12339
PMID: 31393660


Immune checkpoint inhibitors (ICIs) are increasingly used and are becoming the standard of care in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Neurological irAEs are rare but potentially severe. Neuromuscular disorders represent the most common neurological irAEs following anti-PD-1, anti-PD-L1, and anti-CTLA-4 treatment, and include myositis, myasthenia gravis, and demyelinating polyradiculoneuropathy. Instrumental findings may differ from typical neuromuscular disorders occurring outside ICIs treatment. Despite initial severity, neurological irAEs often respond to immune-modulating therapies. Prompt irAEs diagnosis, ICIs discontinuation, and early treatment with corticosteroids, together with patient education and a multi-disciplinary approach, are important for optimizing clinical outcomes. Intravenous immunoglobulin, plasma exchange, and other immune-modulating treatments should be considered in more severe cases. Consideration of re-challenging with the same immunotherapy drug may be given in some cases, based on clinical picture and initial severity of irAEs. © 2019 Peripheral Nerve Society.

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