Immune checkpoint inhibitors and neuromuscular adverse events

Neuromuscular adverse events (AEs) in cancer patients treated with immune checkpoint inhibitors (ICIs) are characterized by diverse clinical subsets. The general features of neuromuscular AEs have remained elusive due to its low frequency, ranging from 1-2% of cancer patients undergoing ICIs therapy. The diseases affect the central nervous system, peripheral nerves, neuromuscular junction, and muscle. Disease onset and progression may be rapid with a critical clinical course. The clinical presentation may differ from that of patients whose symptoms are unrelated to drugs. Headache, dizziness, and dysgeusia are relatively common and mild treatment-related AEs. In contrast, immune-related AEs, such as autoimmune encephalitis, demyelinating polyneuropathy, myasthenia, and myositis are more serious conditions. There is a strong correlation between ICIs and myasthenia, myositis, and myocarditis. Immune-modulating medication is generally effective for neuromuscular AEs. However, there are guidelines for treatment, and checkpoint inhibitor therapy should be withheld until the pathophysiology of the AEs is defined. Both CD8+cytotoxic T cells and autoantibodies are involved in the pathogenesis of neuromuscular AEs. Therefore, understanding the mechanisms of neuromuscular AEs is necessary to alleviate the symptoms associated with ICIs therapy in cancer patients.