کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5526428 1547050 2017 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
ReviewMyasthenia gravis: An emerging toxicity of immune checkpoint inhibitors
موضوعات مرتبط
علوم زیستی و بیوفناوری بیوشیمی، ژنتیک و زیست شناسی مولکولی تحقیقات سرطان
پیش نمایش صفحه اول مقاله
ReviewMyasthenia gravis: An emerging toxicity of immune checkpoint inhibitors
چکیده انگلیسی


- Twenty-three reported cases of immune checkpoint inhibitor-associated myasthenia gravis (MG).
- Approximately, 70% of cases were de novo presentations.
- There is a 30.4% MG-specific mortality associated with immune checkpoint inhibition.
- Average onset of MG symptoms is within 6 weeks of treatment initiation.
- Early recognition of symptoms and robust treatment is essential.

The advent of immunotherapy has heralded a number of significant advances in the treatment of particular malignancies associated with poor prognosis (melanoma, non-small-cell lung, renal and head/neck cancers). The success witnessed with therapeutic agents targeting cytotoxic T-lymphocyte-associated protein 4, programmed cell death protein 1 and programmed cell death ligand 1 immune checkpoints has inevitably led to an explosion in their clinical application and the subsequent recognition of specific toxicity profiles distinct from those long recognised with chemotherapy. Consequently, as the utility of such therapies broaden, understanding the nature, timing and management of these immune-related adverse events (irAEs) becomes increasingly significant. Although neurological irAEs are considered relatively rare in comparison with hepatitis, colitis, pneumonitis and endocrinopathies, one emerging side-effect is myasthenia gravis (MG). Among the 23 reported cases of immune checkpoint inhibitor-associated MG, 72.7% were de novo presentations, 18.2% were exacerbations of pre-existing MG and 9.1% were exacerbations of subclinical MG. The average onset of symptoms was within 6 weeks (range 2-12 weeks) of treatment initiation. In addition, there was no consistent association with elevated acetylcholine antibody titres and the development of immune checkpoint inhibitor-related MG. Significantly, there was a 30.4% MG-specific-related mortality, which further emphasises the importance of early recognition and robust treatment of this toxicity. In addition to a review of the existing literature, we present a new case of pembrolizumab-induced MG and provide insights into the underlying mechanisms of action of this phenomenon.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: European Journal of Cancer - Volume 82, September 2017, Pages 128-136
نویسندگان
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