Departments of Dermatology.
Neurology.
J Immunother. 2019 Oct;42(8):309-312. doi: 10.1097/CJI.0000000000000278.
Immune checkpoint inhibitors deeply improved the prognosis of metastatic melanoma or other types of cancer, but their related adverse effects (AEs) can be very severe, especially when the neurological system is touched, as in myasthenia gravis (MG). It is a rare immune AE that can be life-threatening and can be revealed by several symptoms. We report a case of our experience and review the current literature of MG exacerbated or occurring during immunotherapy to describe characteristics of this AE, warn the oncologist about this toxicity, and summarize the treatments conducted. Thirty-four cases of MG were reported, mostly with anti-programmed cell death protein 1 checkpoint inhibitor, and with melanoma. Onset was quick after the first or second infusion. Treatment comprised corticosteroids, prostigmine, and more or less plasmapheresis or immunoglobulins. Prognosis is poor, as 13 patients died after MG. MG is a rare immune-related AE that must be rapidly evoked and treated in case of neurological symptoms emerging after immunotherapy.
免疫检查点抑制剂极大地改善了转移性黑色素瘤或其他类型癌症的预后，但它们相关的不良反应（AE）可能非常严重，特别是当神经系统受到影响时，如重症肌无力（MG）。这是一种罕见的免疫 AE，可能危及生命，并可能由多种症状表现出来。我们报告了我们的一例经验，并回顾了目前关于免疫治疗期间或之后发生的 MG 恶化或出现的文献，以描述这种 AE 的特征，提醒肿瘤学家注意这种毒性，并总结所进行的治疗。报告了 34 例 MG，大多数与抗程序性死亡蛋白 1 检查点抑制剂和黑色素瘤有关。在第一次或第二次输注后很快发病。治疗包括皮质类固醇、拟副交感神经药，以及或多或少的血浆置换或免疫球蛋白。预后很差，因为有 13 例患者在 MG 后死亡。MG 是一种罕见的免疫相关 AE，必须在免疫治疗后出现神经系统症状时迅速引发和治疗。
