ICI Neuropathy — SCE Neurology MCQ

Correct answer: D — Nivolumab withdrawal, respiratory monitoring and immune treatment

The best answer is “Nivolumab withdrawal, respiratory monitoring and immune treatment”. Immune-checkpoint-inhibitor polyradiculoneuropathy can deteriorate rapidly and differs from ordinary idiopathic GBS in treatment considerations; the anticancer drug is withheld while neurology and oncology coordinate IVIg, plasma exchange or corticosteroid-based therapy and respiratory surveillance. “Continue nivolumab while awaiting outpatient follow-up” is less appropriate because continued exposure is unsafe during a severe suspected immune toxicity “Give corticosteroids only if oxygen saturation later falls” is less appropriate because oxygen saturation is a late marker of ventilatory failure and treatment should not await it “Diagnose diabetic neuropathy from the time course alone” is less appropriate because the acute cranial-respiratory syndrome is not a typical chronic diabetic neuropathy “Perform elective nerve biopsy before monitoring vital capacity” is less appropriate because monitoring and therapy should not be delayed for a usually unnecessary biopsy

Reference: Neurological adverse events of immune checkpoint inhibitors: consensus definitions. https://pmc.ncbi.nlm.nih.gov/articles/PMC8291304/