085  Durvalumab-induced fatal myasthenia gravis. Issue 6 (27th May 2022)

• Record Type: Journal Article
• Authors: Dodd, Katherine; Sussman, Jonathan
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 93:Issue 6(2022)
• Page Start: A38
• Page End: A39
• Publication Date: 2022-05-27
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2022-ABN.122
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : In recent years a number of immune checkpoint inhibitors (ICIs) have been developed for use in oncology, as treatment strategies increasingly focus on targeted therapies and immunotherapies. These include monoclonal antibodies against programmed cell death receptor-1 (PD-1), it's ligand programmed death ligand 1 (PD-L1), and cytotoxic T lymphocyte antigen-4 (CTLA-4). ICIs aim to prevent tumour cells from evading immune attack by downregulating T cell responses, and are proving to be clinically beneficial compared with standard chemotherapy in various advanced solid tumours. The main side effect is of immune dysregulation, causing or exacerbating pre-existing autoimmune conditions, such as myasthe- nia gravis (MG). We report a case of a 77 year old gentleman, treated with durvalumab (a PD-L1 inhibitor), for clear cell renal carcinoma, who developed severe de novo MG, refractory to treatment, and died. We summarise the literature on de novo and exacerbations of pre-existing or subclinical MG with ICI use, and the high mortality rates seen with these. We believe that this is the first reported case of MG presenting in a patient with sole durvalumab use; without an additional ICI. It adds to the growing literature on the risks of severe ICI-related MG. [e-mail]