Myasthenia gravis and myopathy after nivolumab treatment for non‐small cell lung carcinoma: A case report

Abstract

Here, we report a case of myasthenia gravis and myopathy in a patient treated with nivolumab. A 76‐year‐old man who had been treated with four doses of nivolumab because of non‐small cell lung cancer (NSCLC) presented with proximal‐dominant muscle weakness and fluctuating ptosis and diplopia. Serologic studies revealed increased levels of muscle enzymes including creatine phosphokinase (2934 U/L), and acetylcholine receptor antibody was positive (1.31 nmol/L). Following electrodiagnostic study, he was diagnosed with myasthenia gravis and active stage of myopathy. After discontinuation of nivolumab, he was treated with corticosteroids, intravenous immunoglobulin G, and pyridostigmine. The neuromuscular symptoms and serologic abnormalities of the patient markedly improved. Currently, he is taking oral steroids and pyridostigmine without further immunotherapy.

Comparative efficacy of immune checkpoint inhibitors combined with chemotherapy in patients with advanced driver-gene negative non-small cell lung cancer: A systematic review and network meta-analysis

“…The application of immunotherapy in the treatment of malignant tumors has reached a mature stage, and its effectiveness in treating non-small cell lung cancer (NSCLC) is gradually being established. However, the use of immune checkpoint inhibitors (ICIs) can activate T-cells that in turn may cause adverse events in different organs, including the endocrine glands, gastrointestinal tract, skin, lungs, liver, kidneys, neurological system, muscles, and blood [ 73 , [92] , [93] , [94] , [95] ]. To address these challenges, it is crucial to develop a tailored chemoimmunotherapy regimen for patients, enhancing the efficacy of combination therapy while minimizing adverse effects.…”

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

“…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 ).…”

Immunotherapy in Elderly Patients Affected by Non-Small Cell Lung Cancer: A Narrative Review

“…Several irAEs of special interest have been described in elderly patients treated with PD1/PD-L1 axis inhibitors and are summarized in Table 2. They included severe cutaneous adverse reactions [135][136][137][138][139][140], secondary sclerosing cholangitis [141], colangiopathy [142,143], immune-related hepatitis [144,145], type 1 diabetes [146][147][148], hypophysitis [149], primary adrenal insufficiency [150], myasthenia gravis and myopathy [151][152][153][154], myocarditis [154][155][156][157], severe heart failure [158], eosinophilic vasculitis and arteritic anterior ischemic optic neuropathy [159], blue toe syndrome due to peripheral vasculitis [160], Vogt-Koyanagi-Harada Disease-like Uveitis [161], acute interstitial nephritis [134,162], fulminant Goodpasture's disease [163], neuromyelitis optica [164], isolated optic neuritis [165], encephalitis [166], hypereosinophilia [167], severe neutropenia [144,[168][169][170], immune thrombocytopenia [171], autoimmune hemolytic anemia and hemophagocytic lymphohist...…”