McCormack Sean M, Hamad Amar
Medicine, Saint James School of Medicine, Park Ridge, USA.
Hematology and Medical Oncology, Affiliated Oncologists, Chicago Ridge, USA.
Cureus. 2023 Sep 6;15(9):e44799. doi: 10.7759/cureus.44799. eCollection 2023 Sep.
Pembrolizumab is a monoclonal antibody that targets the programmed cell death protein 1 (PD-1) receptor on T-cells, thereby enhancing the antitumor immune response. Pembrolizumab has been shown to improve survival in various cancers, but it can also cause immune-related adverse events (irAEs), which can affect any organ system. We report two cases of rare but serious irAEs caused by pembrolizumab: myasthenia gravis (MG) and peripheral neuropathy. Both patients presented with neuromuscular symptoms after receiving pembrolizumab for their advanced cancers. They were diagnosed with MG and peripheral neuropathy based on their clinical features, laboratory tests, and unremarkable imaging. Treatment involved discontinuing pembrolizumab and initiating immunosuppressive and supportive therapies. Both patients experienced improvement in their symptoms and quality of life once pembrolizumab was permanently discontinued and supportive therapies were in place. These cases highlight the importance of recognizing and managing rare irAEs of pembrolizumab, such as MG and peripheral neuropathy. Early diagnosis and treatment can improve outcomes and reduce morbidity. Furthermore, these cases emphasize the need for continued post-marketing surveillance to accurately assess the risk of less frequent adverse drug reactions seen in patients on pembrolizumab. Knowledge of these adverse reactions is important when discussing the pros and cons of this novel therapy with patients.
帕博利珠单抗是一种单克隆抗体，可靶向T细胞上的程序性细胞死亡蛋白1（PD-1）受体，从而增强抗肿瘤免疫反应。已证明帕博利珠单抗可改善多种癌症患者的生存率，但它也可能导致免疫相关不良事件（irAE），可影响任何器官系统。我们报告了两例由帕博利珠单抗引起的罕见但严重的irAE：重症肌无力（MG）和周围神经病变。两名患者在接受帕博利珠单抗治疗晚期癌症后均出现神经肌肉症状。根据他们的临床特征、实验室检查和无异常的影像学表现，他们被诊断为MG和周围神经病变。治疗包括停用帕博利珠单抗并启动免疫抑制和支持性治疗。一旦永久停用帕博利珠单抗并实施支持性治疗，两名患者的症状和生活质量均有所改善。这些病例凸显了认识和管理帕博利珠单抗罕见irAE（如MG和周围神经病变）的重要性。早期诊断和治疗可改善预后并降低发病率。此外，这些病例强调需要持续进行上市后监测，以准确评估接受帕博利珠单抗治疗的患者中较少见的药物不良反应风险。在与患者讨论这种新型疗法的利弊时，了解这些不良反应很重要。
