Can Immunotherapy Cause Nerve Pain, and How Can You Cope?

Yes, immunotherapy can sometimes cause nerve-related symptoms such as numbness, tingling, burning, and pain in the hands and feet (peripheral neuropathy). Some checkpoint inhibitors and antibody–drug conjugates can affect peripheral nerves, leading to sensory changes or weakness. ^[1] These symptoms may be mild and short-lived or, in some cases, persist longer and impact daily activities like buttoning a shirt or walking. ^{[1] [2]}

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What This Side Effect Looks Like

• Sensory changes: Numbness, tingling (pins-and-needles), burning, or pain in fingers and toes that can spread in a “glove and stocking” pattern. ^[3]
• Motor issues: Difficulty with fine tasks (gripping a pen, fastening buttons) or problems feeling the ground while walking; occasionally weakness. ^{[4] [1]}
• Course: Symptoms can start after a few doses and may be dose-related or cumulative; occasionally they can appear early. ^[5] Some neuropathies improve after treatment adjustments, while others can linger. ^{[1] [5]}

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Why It Happens

Anti-cancer therapies can injure or inflame peripheral nerves, and newer agents like checkpoint inhibitors and certain antibody–drug conjugates are associated with treatment-induced peripheral neuropathy. ^[6] This typically causes a symmetrical sensory neuropathy in the fingers and toes, sometimes progressing to hands and feet. ^[3]

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When to Contact Your Care Team

• New or worsening numbness/tingling, burning pain, or trouble walking should be reported promptly, as early management can prevent progression. ^[1]
• Red flags: Rapidly progressive weakness, severe pain, difficulty breathing or swallowing, or cranial nerve symptoms (e.g., facial weakness or double vision) deserve urgent evaluation; high-grade neurological reactions may require stopping immunotherapy and starting corticosteroids, and if steroid-resistant, escalation to treatments like IVIg or plasma exchange. [PM13] [PM14]

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How Clinicians Manage It

• Grading and adjustment: Clinicians grade neuropathy severity and may hold, reduce, or discontinue the causative drug based on the grade. For example, with enfortumab vedotin, Grade 2 neuropathy often leads to a treatment delay until improvement and dose reduction if it recurs; Grade 3–4 typically requires cessation. ^[2]
• Supportive medications: Depending on symptoms, your team may suggest medicines for neuropathic pain (such as duloxetine or gabapentinoids), though choices are individualized. ^[1]
• Immune-related events: For suspected immune-mediated neuropathies from checkpoint inhibitors, corticosteroids are usually first-line, with escalation to IVIg or plasma exchange for severe or steroid-refractory cases. [PM13] [PM14]

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Practical Coping Strategies at Home

• Stay active: Gentle, regular exercise helps circulation, balance, and mood; a physical therapist can tailor safe routines. ^[7]
• Protect your feet and hands: Wear cushioned shoes and avoid walking barefoot to reduce injury risk when sensation is reduced. ^[1]
• Safety upgrades at home: Use handrails, non-slip mats, and good lighting to prevent falls. ^[1]
• Lifestyle steps: Stop smoking to support nerve health and blood flow; moderate alcohol as it can worsen neuropathy. ^[7]
• Self-care routines: Warm (not hot) baths, gentle massage, and relaxation techniques may ease discomfort. ^[1]
• Nutrition and hydration: Balanced meals and staying hydrated can support overall recovery and energy levels. ^[1]
• Symptom diary: Track onset, triggers, and daily impact to help your team tailor treatment and decide on dose changes. ^[5]

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What to Expect Over Time

Many neuropathies improve with dose adjustments, pauses, or targeted treatment, but recovery can vary. Some symptoms resolve within weeks, while others may take months or remain to a degree, especially if nerve injury was substantial. ^[5] Your care team will balance cancer control with nerve safety, aiming to maintain effective therapy while limiting long-term nerve problems. ^[5]

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Key Takeaways

• Immunotherapy can affect peripheral nerves, causing numbness, tingling, pain, or weakness; these symptoms should be promptly discussed with your cancer team. ^{[1] [6]}
• Early reporting and grading guide safe adjustments like holding or reducing the drug, and clinicians have strategies ranging from pain control to immune therapies for severe cases. ^[2] [PM14]
• Daily coping strategies exercise, safety modifications, foot and hand care, and lifestyle changes can meaningfully reduce symptoms and protect function. ^{[1] [7]}