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.

免疫检查点抑制剂彻底改变了癌症治疗，并越来越多地用于治疗多种肿瘤疾病，为许多患者带来了巨大的好处。不幸的是，由此产生的 T 细胞效应功能的增强通常会导致免疫相关不良事件 (irAE)，这可能涉及任何器官系统，包括中枢神经系统 (CNS) 和周围神经系统 (PNS)。三分之二的受影响患者中，神经系统 irAE 涉及三七总皂甙。肌肉受累（免疫相关性肌病）是最常见的 PNS irAE，可能与神经肌肉接头受累有关。免疫相关的周围神经病最常见的形式是多发性神经根神经病或颅神经病。免疫相关性肌病（有或没有神经肌肉接头受累）通常与免疫相关性心肌炎一起发生，这种重叠综合征与死亡率大幅增加有关。本综述重点关注与免疫检查点抑制相关的三七总皂苷不良事件。讨论了潜在的病理生理学机制，包括自身与肿瘤之间的抗原同源性、表位扩散和预先存在的自身反应性 T 细胞的激活。概述了当前的临床管理方法，包括旨在将抗癌免疫与自身免疫脱钩的细胞因子导向疗法，以及针对严重（危及生命）表现的患者的新兴疗法。