Frontiers in Oncology (Feb 2019)

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

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

DOI
https://doi.org/10.3389/fonc.2019.00084
Journal volume & issue
Vol. 9

Abstract

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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.

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