Immune Checkpoint Inhibitor-Induced Myasthenia Gravis in a Patient with Advanced NSCLC and Remote History of Thymoma

Lara, Matthew S.; Afify, Alaa M; Ellis, Michael; Phan, Chia Wei; Richman, David P.; Riess, Jonathan W.

doi:10.1016/j.cllc.2019.04.007

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…Moreover, it can be unilateral or bilateral. According to previous studies, ophthalmoplegia in lung cancer secondary to ICIs were accompanied by myasthenia gravis (MG) in all patients ( 25 , 34 – 39 , 46 , 47 , 49 – 51 , 55 – 57 , 60 , 64 , 69 – 76 , 79 , 81 ). Ptosis is the key manifestation of immune-related MG, and accounts for 75%–78.7% of ICI-induced MG (irMG) ( 93 – 96 ).…”

Section: Clinical Characteristic Of Ocular Iraes In Lung Cancer With Icismentioning

confidence: 90%

Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer

Zhou

Wei

2021

Front. Immunol.

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Immune checkpoint inhibitors (ICIs) are novel immunotherapy-based drugs that have become increasingly popular in the treatment of lung cancer. Researchers have recognized ocular immune-related adverse events (irAEs) secondary to ICIs because of their vision-threatening characteristics. However, they are incompletely characterized and no studies have reported the ICI-related ocular irAEs in lung cancer. Therefore, we aimed to comprehensively illustrate the clinical characteristics, contributory factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer, based on previously reported 79 patients. Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most common ICI-related ocular irAEs in lung cancer. Ptosis was the most common (36.71%) and the highest mortality (23.33%) of ophthalmoplegia. Patients in Asia and patients who underwent combination therapy with programmed cell death-1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors demonstrated significantly higher frequency of ophthalmoplegia than other ocular irAEs. Most ICI-related ophthalmoplegia and uveitis in lung cancer were observed in the first 10 weeks following the initiation of ICIs. Furthermore, the onset time of dry eye and other ocular irAEs was much longer. In addition, 92.31% of the patients with ocular irAEs other than ophthalmoplegia could be remised. In conclusion, ocular irAEs secondary to ICIs in lung cancer are non-negligible, particularly ophthalmoplegia. Ethnicity and the type of ICIs play important roles in the distribution of ocular irAEs. ICI-related ophthalmoplegia in lung cancer presented with early onset and worse prognosis features, thus necessitating further attention.

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Section: Clinical Characteristic Of Ocular Iraes In Lung Cancer With Icismentioning

confidence: 90%

Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer

Zhou

Wei

2021

Front. Immunol.

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“…The average onset time of the patient's symptoms appeared within 6 weeks of starting treatment (range 2-12 weeks) (93). Treatment-related reports of myasthenia gravis in NSCLC patients receiving PD-1 monoclonal antibodies seem to be more common than those receiving PD-L1 agents (41,94,95). A 63-year-old female patient with stage IV NSCLC adenocarcinoma, who failed conventional chemotherapy (disease progression) and subsequently used pembrolizumab, was diagnosed with myasthenia gravis after two cycles of treatment (41).…”

Section: Myasthenia Gravismentioning

confidence: 99%

“…Treatment-related reports of myasthenia gravis in NSCLC patients receiving PD-1 monoclonal antibodies seem to be more common than those receiving PD-L1 agents (41,94,95). A 63-year-old female patient with stage IV NSCLC adenocarcinoma, who failed conventional chemotherapy (disease progression) and subsequently used pembrolizumab, was diagnosed with myasthenia gravis after two cycles of treatment (41). The clinical symptoms are bilateral eyelid drooping, extraocular muscle paralysis, shortness of breath, and fatigue (41).…”

Section: Myasthenia Gravismentioning

confidence: 99%

“…A 63-year-old female patient with stage IV NSCLC adenocarcinoma, who failed conventional chemotherapy (disease progression) and subsequently used pembrolizumab, was diagnosed with myasthenia gravis after two cycles of treatment (41). The clinical symptoms are bilateral eyelid drooping, extraocular muscle paralysis, shortness of breath, and fatigue (41). Moreover, two patients with NSCLC who received nivolumab reported myasthenia gravis, and the onset time was within 2-3 cycles after the start of treatment (94,95).…”

Section: Myasthenia Gravismentioning

confidence: 99%

“…In addition, the most common treatment-related adverse events (TRAEs) include fatigue, fever/chillness and infusion reactions ( 9 ). Furthermore, rare and serious TRAEs have been reported, including immune-related encephalitis ( 40 ), myasthenia gravis ( 41 ), acute renal failure/interstitial nephritis ( 42 ), and myocarditis ( 43 ). Here, we list the TRAEs caused by PD-1 and PD-L1 inhibitors in the treatment of NSCLC in Tables 1 , 2 , respectively, both monotherapy and combination therapy are included.…”

Section: Adverse Effects Based On Pd-1/pd-l1 Blockade For Nsclc Theramentioning

confidence: 99%

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Adverse Effects of Anti-PD-1/PD-L1 Therapy in Non-small Cell Lung Cancer

Wang

Liu

et al. 2020

Front. Oncol.

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Currently, immunotherapy has shown great efficacy in clinical trials, and monoclonal antibodies directed against immune checkpoint PD-1/PD-L1 have shown encouraging results in first-line or second-line treatment of non-small cell lung cancer patients. Meanwhile, anti-PD-1/PD-L1 immune checkpoint drugs combined with other treatments, such as chemotherapy, targeted therapy as well as anti-CTLA-4 checkpoint therapy, are considered an attractive treatment with higher efficacy. However, toxicity associated with PD-1/PD-L1 blockade is worth attention. Understanding the adverse effects caused by anti-PD-1/PD-L1 immunosuppressive agents is vital to guide the clinical rational use of drug. In this review, we summarized the adverse effects that occurred during the clinical use of anti-PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer and discussed how to effectively manage and respond to these adverse reactions.

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Pembrolizumab

2019

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Immune Checkpoint Inhibitor-Induced Myasthenia Gravis in a Patient with Advanced NSCLC and Remote History of Thymoma

Cited by 10 publications

References 8 publications

Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer

Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer

Adverse Effects of Anti-PD-1/PD-L1 Therapy in Non-small Cell Lung Cancer

Pembrolizumab

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