Neuropathy (motor or sensory nerve impairment or damage)

Grading

Management

Overall Strategy:

• Rule out infectious, non-infectious, disease-related etiologies
• High-dose steroids (1–2 mg/kg/day prednisone or equivalent) to be used
• Ipilimumab to be withheld for Grade 2 event, nivolumab for first occurrence of Grade 3 event, and pembrolizumab based on disease severity; ipilimumab to be discontinued for Grade 2 events persisting ≥6 weeks or inability to reduce steroid dose to ≤7.5 mg prednisone or equivalent per day; pembrolizumab or nivolumab to be discontinued for Grade 3/4 events that recur, persist ≥12 weeks, or inability to reduce steroid dose to ≤10 mg prednisone or equivalent per day
• Neurology consult
  • Consideration of electromyelogram and nerve conduction tests
  • Immune globulin infusions
  • Plasmapheresis
• Taper steroids slowly over at least 4 weeks once symptoms improve
• If needed, obtain physical therapy or occupational therapy consult (for both functional assessment and evaluate safety of patient at home)
• Supportive medications for symptomatic management