An Extensive-stage Small-cell Lung Cancer Case With Preexisting Lambert-Eaton Myasthenic Syndrome Successfully Treated With an Immune Checkpoint Inhibitor

Tadashi Sakaguchi,Yasumasa Kokubo,Kazuki Furuhashi,Yuki Nakamura,Yuta Suzuki,Kentaro Ito,Kentaro Fujiwara,Yoichi Nishii,Osamu Taguchi,Osamu Hataji

doi:10.1016/j.cllc.2021.09.001

Tadashi Sakaguchi, Yasumasa Kokubo + Show 8 more

Open Access

https://doi.org/10.1016/j.cllc.2021.09.001

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Journal: Clinical lung cancer	Publication Date: Sep 17, 2021
Citations: 8	License type: cc-by

Affiliation: Soka Municipal Hospital, Mie University

Abstract

<h2>Clinical Practice Points</h2> <ul><li>•Immune checkpoint inhibitor (ICI) therapy could exacerbate preexisting active autoimmune diseases (AIDs), and the presence of preexisting AIDs might be associated with a greater risk of developing new immune-related adverse events (irAEs).</li><li>•The safety of ICIs for patients with Lambert-Eaton myasthenic syndrome (LEMS), a neuromuscular autoimmune disease known as a paraneoplastic syndrome mainly associated with small-cell lung cancer (SCLC), is fully unknown.</li><li>•We experienced an extensive-stage (ES)-SCLC patient with LEMS successfully treated with chemotherapy in combination with ICI without a flare-up of LEMS.</li><li>•Phase III trials have shown that ICIs in combination with platinum doublet therapy significantly improved the overall survival of patients with ES-SCLC in first-line settings, therefore, patients diagnosed with ES-SCLC with the complication of LEMS have the widespread opportunity to receive ICIs as standard care. This report suggests that treatment using ICIs may be a treatment option to consider for ES-SCLC patients with LEMS.</li></ul>

Highlights

Lambert-Eaton myasthenic syndrome (LEMS), a neuromuscular autoimmune disease known as a paraneoplastic syndrome (PNS) mainly associated with SCLC, is fully unknown
A systematic review suggested that flare-ups of autoimmune disease (AID) and new immune-related adverse events (irAEs) were generally manageable with careful clinical follow-up and prompt therapy, they included few AIDs and irAEs associated with neurological disorders.[3]
One report showed that a patient with paraneoplastic LEMS, which first manifest with Merkel cell carcinoma, exhibited exacerbated LEMS symptoms after treatment with avelumab. In this patient intravenous immunoglobulins improved the condition significantly.[8]. This is the first report about an extensive-stage small-cell lung cancer (ES-SCLC) patient complicated with LEMS successfully treated by immune checkpoint inhibitors (ICIs) plus chemotherapy without a flare-up of LEMS

Summary

Introduction

As phase III trials have shown, anti PD-L1 inhibitors in combination with platinum doublet therapy significantly improved the overall survival of patients with extensive-stage small-cell lung cancer (ES-SCLC) in first-line settings.[1,2] Patients diagnosed with ESSCLC have the widespread opportunity to receive immune checkpoint inhibitors (ICIs) as standard care. The patient had hemoptysis, fatigue when walking, and difficulty getting up for a few weeks On his neurologic examination, bilateral iliopsoas muscle weakness with left predominance was noted, and he had a waddling gait. Magnetic resonance imaging of his brain showed no evidence of metastatic disease He was diagnosed with SCLC using samples taken from an endotracheal tumor in his left upper lobe bronchus. The hemoptysis ceased, and he became able to climb stairs and conduct daily life without any difficulty He has since received second line chemotherapy treatment due to disease progression 5 months after the initiation of first line treatment which included four courses of the first line combination therapy, and the LEMS has not been exacerbated

Discussion

Clinical Lung Cancer 2021

Conclusion

Disclosure