2024 World Conference on Lung Cancer (WCLC) - ePosters-EP.11E.01 Immune-Related Myasthenia Gravis in Patients with NSCLC: A Case Series

Pdf Summary

This document presents a case series focusing on immune-related myasthenia gravis (irMG) in patients with non-small cell lung cancer (NSCLC) undergoing treatment with immune checkpoint inhibitors (ICIs). The authors, affiliated with Kaohsiung Veterans General Hospital and Kaohsiung Medical University in Taiwan, emphasize the need for active monitoring of patients receiving ICI therapy. They highlight that neurological immune-related adverse events (irAEs), such as irMG, can develop, often with an acute onset and rapid progression, leading to a higher mortality rate than classical myasthenia gravis due to complications like respiratory failure and concurrent immune-related conditions like myositis or myocarditis.<br /><br />The paper suggests a causal relationship between PD-(L)1 inhibitors and irMG in lung cancer patients, noting that irAEs are uncommon but serious, with irMG developing in 0.24–0.47% of patients treated with ICIs. Of these, 70% are new-onset cases, and 30% are either pre-existing or subclinical.<br /><br />Early recognition of irMG, discontinuation of ICI therapy, and prompt escalation of treatment, including measures like plasmapheresis and intravenous immunoglobulin, alongside standard treatments such as glucocorticoids and pyridostigmine, are crucial for effective management. The authors acknowledge the lack of understanding in the immunobiology of irMG and recommend further research to elucidate optimal treatment durations and potential risks.<br /><br />Three cases of irMG among NSCLC patients are detailed, highlighting the clinical challenges and treatment approaches. The study calls for more research and prospective registrations of treatment outcomes to better understand and manage irMG in the context of ICI therapy. The work received support from the Medical Foundation in Memory of Dr. Deh-Lin Cheng.

Asset Subtitle

Ying-Ying Kang

Meta Tag

Speaker Ying-Ying Kang

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

immune-related myasthenia gravis

non-small cell lung cancer

immune checkpoint inhibitors

neurological adverse events

PD-L1 inhibitors

plasmapheresis

intravenous immunoglobulin

glucocorticoids

pyridostigmine

Kaohsiung Veterans General Hospital