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Peripheral nervous system immune-related adverse events due to checkpoint inhibition.

Authors :
O'Hare M
Guidon AC
Source :
Nature reviews. Neurology [Nat Rev Neurol] 2024 Sep; Vol. 20 (9), pp. 509-525. Date of Electronic Publication: 2024 Aug 09.
Publication Year :
2024

Abstract

Immune checkpoint inhibitors have revolutionized cancer therapy and are increasingly used to treat a wide range of oncological conditions, with dramatic benefits for many patients. Unfortunately, the resulting increase in T cell effector function often results in immune-related adverse events (irAEs), which can involve any organ system, including the central nervous system (CNS) and peripheral nervous system (PNS). Neurological irAEs involve the PNS in two-thirds of affected patients. Muscle involvement (immune-related myopathy) is the most common PNS irAE and can be associated with neuromuscular junction involvement. Immune-related peripheral neuropathy most commonly takes the form of polyradiculoneuropathy or cranial neuropathies. Immune-related myopathy (with or without neuromuscular junction involvement) often occurs along with immune-related myocarditis, and this overlap syndrome is associated with substantially increased mortality. This Review focuses on PNS adverse events associated with immune checkpoint inhibition. Underlying pathophysiological mechanisms are discussed, including antigen homology between self and tumour, epitope spreading and activation of pre-existing autoreactive T cells. An overview of current approaches to clinical management is provided, including cytokine-directed therapies that aim to decouple anticancer immunity from autoimmunity and emerging treatments for patients with severe (life-threatening) presentations.<br /> (© 2024. Springer Nature Limited.)

Details

Language :
English
ISSN :
1759-4766
Volume :
20
Issue :
9
Database :
MEDLINE
Journal :
Nature reviews. Neurology
Publication Type :
Academic Journal
Accession number :
39122934
Full Text :
https://doi.org/10.1038/s41582-024-01001-6