Myasthenia gravis during treatment with anti-PD-1 - succesfull treatment using pirydostygminum – case report and literature review

Tywanek, Ewa, Jankowska, Katarzyna, Zwolak, Agnieszka, Zgliczyński, Wojciech. Myasthenia gravis during treatment with anti-PD-1 - succesfull treatment using pirydostygminum – case report and literature review. Journal of Education, Health and Sport. 2022;12(12):11-16. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2022.12.12.001

https://apcz.umk.pl/JEHS/article/view/40242

https://zenodo.org/record/7308867

The journal has had 40 points in Ministry of Education and Science of Poland parametric evaluation. Annex to the announcement of the Minister of Education and Science of December 21, 2021. No. 32343.

Has a Journal's Unique Identifier: 201159. Scientific disciplines assigned: Physical Culture Sciences (Field of Medical sciences and health sciences); Health Sciences (Field of Medical Sciences and Health Sciences).

Punkty Ministerialne z 2019 - aktualny rok 40 punktów. Załącznik do komunikatu Ministra Edukacji i Nauki z dnia 21 grudnia 2021 r. Lp. 32343. Posiada Unikatowy Identyfikator Czasopisma: 201159.

Przypisane dyscypliny naukowe: Nauki o kulturze fizycznej (Dziedzina nauk medycznych i nauk o zdrowiu); Nauki o zdrowiu (Dziedzina nauk medycznych i nauk o zdrowiu).

© The Authors 2022;

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Received: 27.09.2022. Revised: 20.10.2022. Accepted: 08.11.2022.

Myasthenia gravis during treatment with anti-PD-1 - succesfull treatment using  pirydostygminum – case report and literature review

Ewa Tywanek¹, Katarzyna Jankowska², Agnieszka Zwolak¹, Wojciech Zgliczyński² , Robert Jan Łuczyk¹

1 Department of Internal Medicine and Internal Medicine in Nursing, Chair of Conservative Nursing, Medical University of Lublin, Poland

2 Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland

Corresponding author:

Ewa Tywanek, Department of Internal Medicine and Internal Medicine in Nursing, Chair of Conservative Nursing, Medical University of Lublin, Chodźki 7, 20-093 Lublin, Poland; (+48) 609293246, (+48) 814487720; ewa.tywanek@gmail.com;  ORCID: 0000-0002-2311-994X 

Founding:

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest:

The authors have no conflict of interest to declare.

Abstract

Background: Against limited effectiveness of known oncological treatment such as chemio-and radiotherapy or surgery, new ways of treatment, such as for example immunotherapy has developed. Usage of immune checkpoint inhibitors (ICPIs), resulting in overactivation of immune system, may significantly raise efficacy of oncological treatment, but simultaneously predispose to occurrence various autoimmunological health complications. Adverse actions of the therapy may affect multiple organs and systems, with the presented example of immune-related neurological complication, myasthenia gravis. This relatively rare condition may be severe, life-threatening illness.

Case report: We present a case of 66-year-old male patient diagnosted with a large tumor histopathologically assessed as squamous cell carcinoma. Due to ineffectiveness of implemented chemio- and radiotherapy, he was qualified for anti-PD1 immunotherapy with nivolumab. General treatment tolerance was very good with positive antineoplastic effect. Autoimmune hypothyroidism has emerged, therefore levothyroxine therapy has been implemented. After about a year of using immunotherapy, significant weakness and decrease in muscle strength has appeared, subsequently, immunotheraphy-related myasthenia gravis was raised. Improvement in the patient's condition was achieved after initiating pyridostigmine treatment. Cessation of antineoplastic treatment wasn’t necessary, what is unusual.

Conclusions:

Undeniably myastenia gravis may determine serious, life-threatening adverse effect of immunotherapy. Usually requires withdrawal of applied antioncological treatment, and should be treated with immunomodulators, immunosuppressants or intravenous immunoglobulins or plasmaphaeresis, however – as we present- in some cases may be properly cured only with pyridostygmine.

MeSH Keywords: Carcinoma, Non-Small-Cell Lung , Immunotherapy, Myasthenia Gravis, Nivolumab