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Werner JM, Schweinsberg V, Schroeter M, et al. Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma. Front Oncol. 2019;9:84doi: 10.3389/fonc.2019.00084.
Werner, J. M., Schweinsberg, V., Schroeter, M., von Reutern, B., Malter, M. P., Schlaak, M., Fink, G. R., Mauch, C., & Galldiks, N. (2019). Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma. Frontiers in oncology, 984. https://doi.org/10.3389/fonc.2019.00084
Werner, Jan-Michael, et al. "Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma." Frontiers in oncology vol. 9 (2019): 84. doi: https://doi.org/10.3389/fonc.2019.00084
Werner JM, Schweinsberg V, Schroeter M, von Reutern B, Malter MP, Schlaak M, Fink GR, Mauch C, Galldiks N. Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma. Front Oncol. 2019 Feb 14;9:84. doi: 10.3389/fonc.2019.00084. eCollection 2019. PMID: 30828569; PMCID: PMC6384415.
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Front Oncol. 2019 Feb 14;9:84. doi: 10.3389/fonc.2019.00084. eCollection 2019.

Successful Treatment of Myasthenia Gravis Following PD-1/CTLA-4 Combination Checkpoint Blockade in a Patient With Metastatic Melanoma.

Frontiers in oncology

Jan-Michael Werner, Viola Schweinsberg, Michael Schroeter, Boris von Reutern, Michael P Malter, Max Schlaak, Gereon R Fink, Cornelia Mauch, Norbert Galldiks

Affiliations

  1. Department of Neurology, University of Cologne, Cologne, Germany.
  2. Department of Dermatology, University of Cologne, Cologne, Germany.
  3. Center of Integrated Oncology, University of Cologne, Cologne, Germany.
  4. Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Juelich, Juelich, Germany.

PMID: 30828569 PMCID: PMC6384415 DOI: 10.3389/fonc.2019.00084

Abstract

Currently, the blockade of certain immune checkpoints such as the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) using checkpoint inhibitors is standard of care in patients with metastatic melanoma, especially with BRAF wild-type. However, several checkpoint inhibitor-related complications have been reported, including severe adverse events in the central and peripheral nervous system. In particular, in the recent past, the occurrence of myasthenia gravis following checkpoint inhibitor monotherapy, particularly nivolumab or ipilimumab, has been reported. In contrast, reports on PD-1/CTLA-4 combination blockade-usually with fatal clinical outcome-are scarce. We here report a case with combination immune checkpoint blockade-related myasthenia gravis with favorable clinical outcome.

Keywords: checkpoint inhibitor; immunotherapy; ipilimumab; myasthenic crisis; neuro-oncology; nivolumab

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