The Immune System’s Echo: The Phenomenon of Delayed Neurological Immune-Related Adverse Events (NirAEs) in Adjuvant Immunotherapy

The use of immune checkpoint inhibitors (ICIs) in early-stage settings has shown promise but can lead to chronic immune-related toxicities known as delayed immune-related adverse events (DIREs). These events, occurring after immunotherapy cessation, can affect various organ systems. Fatal immune-related adverse events (irAEs) are relatively rare but significant. Diagnostic challenges exist in distinguishing DIREs from disease sequelae. Efforts are needed to develop evidence-based strategies for managing DIREs as long-term survival with ICIs becomes possible. This case study highlights delayed neurological immune-related adverse events (NirAEs) encountered during pembrolizumab treatment, emphasizing the need for accurate diagnosis and prompt management. Reporting practices in immunotherapy trials hinder accurate assessment of DIREs. Close monitoring, accurate diagnosis, and timely corticosteroid administration are vital for effective DIRE management.