Neuromuscular complications associated with cancer immunotherapy

Immune checkpoint inhibitors (ICIs) and cellular immunotherapy have revolutionized cancer treatment. Although these therapies have significantly improved cancer patients’ survival, they are associated with a range of immune-related adverse events (irAEs) that can affect patients' quality of life. Neuromuscular complications related to cancer immunotherapy are rare (<5 % with monotherapy and up to 14 % with combination therapy), but they can be fatal if not addressed promptly. Early diagnosis and intervention are crucial to improving the quality of life and survival of cancer patients affected by neuromuscular complications associated with immunotherapy. However, symptoms can be diverse and nonspecific, including weakness, numbness, imbalance, dysarthria, dysphagia, and even difficulty in breathing, which presents significant challenges for diagnosis and management. This review summarizes the current understanding of the mechanisms, clinical features, diagnostic challenges, and management strategies for neuromuscular complications related to cancer immunotherapy. Understanding the complex interplay between T cells, B cells, and cytokines in the pathogenesis of neuromuscular irAEs is essential for guiding their management. It is important for healthcare providers, including oncologists, neurologists, primary care physicians, and other practitioners, to be familiar with the multidisciplinary clinical management of neuromuscular irAEs. This knowledge will help reduce the mortality and morbidity associated with these complications.