Deveci Şule, Uzun Mustafa, Özçelik Pinar, Tümer Doğukan Sebile Serranur, Matur Zeliha
Department of Neurology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital.
Department of Neurology, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey.
Anticancer Drugs. 2025 Feb 1;36(2):143-150. doi: 10.1097/CAD.0000000000001665. Epub 2024 Dec 24.
Immune checkpoint inhibitors (ICIs), such as pembrolizumab, have revolutionized cancer treatment by enhancing the immune system's response to malignancies. However, these therapies are associated with immune-related adverse events (irAEs), including neuromuscular complications such as myasthenia gravis, myositis, and myocarditis. We describe two male patients, aged 67 and 68, with small cell and non-small cell lung cancers, who developed progressive neuromuscular symptoms, including ptosis, diplopia, and generalized weakness, after receiving pembrolizumab. Clinical, biochemical, imaging, and electrophysiological findings confirmed the diagnosis of myositis with myastheniform features, with one case also involving myocarditis. Both patients underwent treatments with intravenous immunoglobulin (IVIg), pyridostigmine, and corticosteroids. The first patient, despite aggressive treatment including plasma exchange and rituximab, succumbed to complications from aspiration pneumonia. The second patient showed partial response to pyridostigmine and IVIg but later died due to metastatic cancer progression. A literature review revealed 52 cases of pembrolizumab-associated myositis with myastheniform symptoms, emphasizing its high morbidity and the need for vigilant monitoring. Pembrolizumab-associated myositis with myastheniform symptoms, especially when accompanied by myocarditis, presents a significant clinical challenge with high mortality. Early recognition and aggressive management of these irAEs are crucial to improving outcomes in cancer patients receiving ICIs.
免疫检查点抑制剂（ICIs），如派姆单抗，通过增强免疫系统对恶性肿瘤的反应，彻底改变了癌症治疗方式。然而，这些疗法会引发免疫相关不良事件（irAEs），包括神经肌肉并发症，如重症肌无力、肌炎和心肌炎。我们描述了两名男性患者，年龄分别为67岁和68岁，患有小细胞肺癌和非小细胞肺癌，在接受派姆单抗治疗后出现了进行性神经肌肉症状，包括上睑下垂、复视和全身无力。临床、生化、影像学和电生理检查结果确诊为具有重症肌无力样特征的肌炎，其中一例还累及心肌炎。两名患者均接受了静脉注射免疫球蛋白（IVIg）、吡啶斯的明和皮质类固醇治疗。第一名患者尽管接受了包括血浆置换和利妥昔单抗在内的积极治疗，但仍死于吸入性肺炎并发症。第二名患者对吡啶斯的明和IVIg有部分反应，但后来因转移性癌症进展而死亡。文献综述显示了52例派姆单抗相关的具有重症肌无力样症状的肌炎病例，强调了其高发病率以及进行密切监测的必要性。派姆单抗相关的具有重症肌无力样症状的肌炎，尤其是伴有心肌炎时，会带来重大临床挑战且死亡率很高。对这些免疫相关不良事件的早期识别和积极管理对于改善接受ICIs治疗的癌症患者的预后至关重要。
