神経・筋免疫関連有害事象

抄録

Neurological and muscular immune–related adverse events (irAEs) associated with cancer treatment with immune checkpoint inhibitors (ICIs) include diverse clinical subsets. The frequency seems to be higher than previously recognized, ranging from 3%–5% 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 be different from that of patients unrelated to drugs. Representative irAEs such as autoimmune encephalitis, aseptic meningitis, myelitis, polyradiculoneuropathy, myasthenia gravis, and myositis are usually serious. There is a tight association between myasthenia gravis and myositis, termed as “PD-1 myopathy”. There are guidelines for the diagnosis and treatment of neurological irAEs. For all but the minimum neurological symptoms, ICIs therapy should be withheld until the nature of the irAEs is defined. Immune–modulating medication is generally effective for neurological irAEs. Contribution of neurologists is required for the best management of cancer patients.