Navigating the Neurological Adverse Effects of Cancer Immunotherapy: Challenges and Opportunities

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The development of cancer immunotherapy has redefined how cancer is treated and further, patients will employ immunotherapy to cure cancer by targeting cancerous cells. Nevertheless, neural irAEs have also appeared as this new line of defense; a result of this novel treatment approach. The goal of this narrative review is to present a comprehensive overview of cancer immunotherapy with an emphasis on immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell-based therapies, and bispecific T-cell engagers (BiTEs), including description of the adverse neurological consequences related to these cancer immunotherapies. Electronic databases such as PubMed, Google Scholar, and Web of Science as well as qualitative synthesis of literature were used to conduct the literature search and synthesis of the literature. Neurological irAEs may involve the: peripheral nervous system, (PNS), the central nervous system (CNS), the neuromuscular junction, and the autonomic nervous system. The occurrence and the timing of these complications is different based on type of immunotherapy and personal risk factors. Pathophysiology Immune dysregulation, autoimmunity and neuroinflammation are believed to contribute to the pathophysiology of neurological irAEs. They also have heterogeneous clinical presentations which may complicate diagnosis and may overlap with other conditions. Treatments options comprise withdrawals of immunotherapy and immunosuppressive therapy with corticosteroids as well as further immunomodulatory agents, in severe or defiant cases. Oncologists, neurologists, and other medical workers should collaborate on multidisciplinary terms to provide the highest quality of assistance to the patient. All the patients have full recovery, but some patients develop persistent neurological deficits or even die. Future studies need to be directed to clarify the working mechanisms, determine prescriptive markers, and evidence-based treatment guidelines to enhance patient safety and outcome. With the future of cancer immunotherapy shaping up, there has been a need to better understand the associated neurological complications in order to treat patients and further the potential of the entire field.