Carpal Tunnel Syndrome: A New Adverse Effect of Immune Checkpoint Inhibitors, 11 Cases

Abstract

This study aims at reporting 11 cases of carpal tunnel syndrome (CTS) occurring in patients on immunotherapy. The increasing use of immune checkpoint inhibitors in oncodermatology is associated with the appearance of immunologic adverse effects linked to nonspecific stimulation of the immune system. CTS has not been reported in this context. A retrospective multicenter review was performed on CTSs occurring on immunotherapy and confirmed with electroneuromyography. Data were collated from patients’ files. Most of the time, CTS was severe, bilateral, with a motor deficit and confirmed axonal damage on electroneuromyography. In 4 cases, it was associated with rheumatological adverse effects (arthralgia/inflammatory synovitis). The most effective treatment appeared to be general corticosteroid therapy, even at low doses (<15 mg/d), or surgery. An imputability of the CTS of these patients to immunotherapy was considered due to the unusual intensity of the symptoms and the absence of other predisposing factors (diabetes and dysthyroidism well-controlled). Its combination with other immunologic adverse effects and the efficacy of general corticosteroid therapy suggests an immunologic origin. CTS is probably an immunologic adverse effect of immunotherapy. It is often severe or misleading in presentation and affects quality of life. The recognition of this adverse effect should make it possible to provide patients with appropriate care.

The top 50 most cited articles in carpal tunnel syndrome research

“…It was attracting more and more researchers to focus on the research field, and many papers related to CTS were published. [ 7 , 8 ] However, significant studies pertaining to CTS are often overlooked. It is imperative to conduct a citation analysis to identify the impact of publications in the specific field.…”

“…Besides, novel strategies, such as shock wave therapy [5] and platelet-rich plasma, [6] have been applied to treat patients with CTS in recent years. It was attracting more and more researchers to focus on the research field, and many papers related to CTS were published [7,8] . However, significant studies pertaining to CTS are often overlooked.…”

Anti-cancer therapeutic agents and carpal tunnel syndrome: Clinical, electrodiagnostic, and ultrasound findings in seven patients

“…1,18,20 In Lechevalier and colleagues' study of 11 patients with melanoma treated with pembrolizumab or nivolumab, most cases were severe, bilateral (82%), and involved a motor deficit (54%). 18 The median duration was 3 months (range: 2-24 months) between medication initiation and symptom onset. An EMG confirmed axonal damage in nine (82%) patients, and four (36%) underwent a CTR.…”

“…17 They act by releasing the inhibition of T-lymphocytes to restore antitumor immunity. 18 The ICIs pembrolizumab and nivolumab are humanized monoclonal antibodies that target programmed death-1 (PD-1) and are approved to treat melanoma, nonsmall cell lung carcinoma, and urothelial (bladder) cancer. [17][18][19][20] Pembrolizumab and nivolumab bind to the PD-1 receptor and directly block the interaction between PD-1 and its ligands, thereby augmenting the ability of tumor-directed T-cells to mediate tumor destruction.…”

“…18 The ICIs pembrolizumab and nivolumab are humanized monoclonal antibodies that target programmed death-1 (PD-1) and are approved to treat melanoma, nonsmall cell lung carcinoma, and urothelial (bladder) cancer. [17][18][19][20] Pembrolizumab and nivolumab bind to the PD-1 receptor and directly block the interaction between PD-1 and its ligands, thereby augmenting the ability of tumor-directed T-cells to mediate tumor destruction. 19,20 While these anti-cancer therapeutic agents have shown favorable response rates, the incidence of neuropathy is 0.3-1.0% which often occurs 2-12 weeks after treatment commencement.…”