Exacerbation of myasthenia gravis in a patient with melanoma treated with pembrolizumab

Authors

K H. Lau, Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine, PO Box 208018, New Haven, Connecticut, 06520, USA.
Aditya Kumar, Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine, PO Box 208018, New Haven, Connecticut, 06520, USA.Follow
Irene Hwa Yang, Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine, PO Box 208018, New Haven, Connecticut, 06520, USA.
Richard J. Nowak, Yale University School of Medicine, Department of Neurology, Division of Neuromuscular Medicine, PO Box 208018, New Haven, Connecticut, 06520, USA.

Document Type

Article

Abstract

INTRODUCTION: While anticancer immunotherapies have traditionally focused on activation of the immune system, there is recent interest in disinhibition of the natural antitumor immune response by targeting immune checkpoints such as cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) and programmed death-1 (PD-1). One humanized monoclonal antibody against PD-1, pembrolizumab, was recently approved for treatment of metastatic malignant melanoma. METHODS: We report exacerbation of myasthenia gravis (MG) after treatment with pembrolizumab and provide a brief literature review. RESULTS: We describe a 75-year-old man with stable MG who experienced myasthenic crisis in the setting of pembrolizumab treatment. A concurrent azathioprine taper was a possible although unlikely contributor given the short time interval between taper and exacerbation. CONCLUSIONS: As long-term data become available regarding the adverse immune effects of novel checkpoint inhibitors, clinicians should be mindful of their risks/benefits and of possible autoimmune disease exacerbation. Muscle Nerve 54: 157-161, 2016.

Medical Subject Headings

Aged; Antibodies, Monoclonal, Humanized (adverse effects); Antineoplastic Agents (adverse effects); Humans; Male; Melanoma (complications, drug therapy); Myasthenia Gravis (chemically induced, complications)

Publication Date

6-1-2016

Publication Title

Muscle & nerve

E-ISSN

1097-4598

Volume

54

Issue

1

First Page

157

Last Page

61

PubMed ID

27065302

Digital Object Identifier (DOI)

10.1002/mus.25141

Recommended Citation

Lau, K H.; Kumar, Aditya; Yang, Irene Hwa; and Nowak, Richard J., "Exacerbation of myasthenia gravis in a patient with melanoma treated with pembrolizumab" (2016). Neurology. 1669.
https://scholar.barrowneuro.org/neurology/1669