Myasthenia gravis induced by nivolumab in patients with non-small-cell lung cancer: a case report and literature review. (August 2017)

• Record Type: Journal Article
• Authors: Hasegawa, Yoshikazu; Kawai, Shigeru; Ota, Takayo; Tsukuda, Hiroshi; Fukuoka, Masahiro
• Is Part Of: Immunotherapy. Volume 9:Number 9(2017)
• Page Start: 701
• Page End: 707
• Publication Date: 2017-08
• Subjects: myasthenia gravis -- nivolumab -- non-small-cell lung cancer; Immunotherapy -- Periodicals; 615.37
• DOI: 10.2217/imt-2017-0043
• Languages: English
• ISSNs: 1750-743X

Abstract

A 76-year-old woman who was diagnosed with non-small-cell lung cancer presented with left eyelid ptosis and grade 4 creatine phosphokinase elevation after the second cycle of nivolumab monotherapy. Nivolumab has demonstrated promising efficacy in patients with non-small-cell lung cancer in several trials. Dyspnea and muscle weakness developed rapidly with an acute exacerbation. She underwent plasmapheresis and intravenous immune globulin followed by treatment with low-dose prednisolone. She had gradual symptoms improvement. We diagnosed her with myasthenia gravis (MG) based on her symptoms and the detection of anti-acetylcholine receptor antibody. According to postmarketing surveillance in 15, 740 Japanese patients, the total incidence rate of MG is 0.1%. We report a rare case of drug-induced MG in a patient receiving nivolumab.