Neurologic Complications of Cancer and Immunotherapy

Cancer and its treatments can affect every level of the nervous system, from the brain and spinal cord to the peripheral nerves, neuromuscular junction, and muscle. As cancer survival improves and immunotherapy becomes more common, neurologists and oncologists are increasingly confronted with complex neurologic problems in patients with malignancy. These complications may result from the tumor itself (brain metastases, leptomeningeal disease, spinal cord compression), from traditional therapies (chemotherapy-induced neuropathy, radiation myelopathy, cognitive effects), or from newer immune checkpoint inhibitors and cellular therapies that trigger immune-mediated neurologic toxicity. Distinguishing between these etiologies is essential, as management strategies and prognostic implications differ significantly.

This CME activity provides a practical, case-based review of neurologic complications of cancer and immunotherapy. The session walks through common clinical presentations—acute weakness, encephalopathy, seizures, ataxia, neuropathic pain—and organizes them by anatomic level and likely cause. Learners will review how to triage neurologic emergencies such as spinal cord compression, brain metastases with mass effect, and leptomeningeal disease, including when to obtain urgent MRI of the brain and entire spine, when to start high-dose corticosteroids, and when to involve neurosurgery and radiation oncology.

The course further explores treatment-related neurotoxicity, including chemotherapy-induced peripheral neuropathy, posterior reversible encephalopathy syndrome, radiation necrosis, and radiation myelopathy. Special attention is given to paraneoplastic neurologic syndromes and immune-related adverse events from checkpoint inhibitors (e.g., autoimmune encephalitis, myelitis, neuropathies, myasthenia-like syndromes), with an emphasis on recognition, diagnostic work-up, coordination with oncology to hold or discontinue therapy, and prompt immunosuppressive treatment.

By the end of this activity, clinicians will be better equipped to recognize, evaluate, and manage neurologic complications in cancer patients, balancing effective oncologic treatment with preservation of neurologic function and quality of life.

Educational Objectives

After completing this activity, learners will be able to:

• Develop a structured approach to managing cancer patients who present with neurologic disorders.
• Identify and describe common neurologic complications of chemotherapy and radiation therapy.
• Recognize and explain paraneoplastic syndromes and neurologic complications of immunotherapy and outline appropriate diagnostic and treatment strategies.

Who Should Do This Course?

• Clinicians evaluating cancer patients with new neurologic symptoms such as weakness, sensory change, confusion, or seizures.
• Neurologists consulted on suspected treatment-related neurotoxicity or paraneoplastic syndromes.
• Oncologists and advanced practice providers prescribing chemotherapy, radiation, or immunotherapy need to recognize neurologic adverse events early.
• Providers involved in triaging neurologic emergencies in patients with known or suspected malignancy.
• Multidisciplinary team members (neuro-oncology, oncology, radiation oncology, palliative care) are seeking a shared framework for managing complex neurologic complications.

Did You Know?

• Up to one-third of patients with systemic cancer will develop brain metastases during their illness, making it one of the most common neurologic complications of malignancy. (Cancer Treat Rev. 2020)
• Leptomeningeal metastasis occurs in a clinically significant proportion of patients with solid tumors and hematologic cancers and is associated with rapid neurologic decline if untreated. (Semin Oncol. 2020)
• Chemotherapy-induced peripheral neuropathy affects approximately 30–40% of patients receiving platinum agents, taxanes, and vinca alkaloids. (Front Mol Neurosci. 2017)
• Neurologic immune-related adverse events (irAEs) from immune checkpoint inhibitors, though less common than other toxicities, can be rapidly disabling or life-threatening without early intervention. (Neurology. 2019)
• Paraneoplastic neurologic syndromes often precede a cancer diagnosis and are strongly associated with small-cell lung cancer, gynecologic tumors, and thymoma. (Nat Rev Clin Oncol. 2019)
• Radiation necrosis can occur months to years after treatment, and distinguishing it from tumor recurrence often requires advanced MRI techniques or PET imaging. (Neurosurg Focus. 2019)

The estimated time to complete this activity is 1 hour.