Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature

Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our instituti...
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Autor*in:	Houssein Safa [verfasserIn] Daniel H Johnson [verfasserIn] Van Anh Trinh [verfasserIn] Theresa E Rodgers [verfasserIn] Heather Lin [verfasserIn] Maria E Suarez-Almazor [verfasserIn] Faisal Fa’ak [verfasserIn] Chantal Saberian [verfasserIn] Cassian Yee [verfasserIn] Michael A Davies [verfasserIn] Sudhakar Tummala [verfasserIn] Karin Woodman [verfasserIn] Noha Abdel-Wahab [verfasserIn] Adi Diab [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Schlagwörter:	Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy

Übergeordnetes Werk:	In: Journal for ImmunoTherapy of Cancer - BMJ Publishing Group, 2013, 7(2019), 1, Seite 11
Übergeordnetes Werk:	volume:7 ; year:2019 ; number:1 ; pages:11

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1186/s40425-019-0774-y

Katalog-ID:	DOAJ03538963X

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520			\|a Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients.
650		4	\|a Myasthenia gravis
650		4	\|a Immune checkpoint inhibitors
650		4	\|a Nivolumab
650		4	\|a Pembrolizumab
650		4	\|a Ipilimumab
650		4	\|a Immunotherapy
653		0	\|a Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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allfields	10.1186/s40425-019-0774-y doi (DE-627)DOAJ03538963X (DE-599)DOAJe15faeb18fd048fe83f36c7b0f6564db DE-627 ger DE-627 rakwb eng RC254-282 Houssein Safa verfasserin aut Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients. Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Daniel H Johnson verfasserin aut Van Anh Trinh verfasserin aut Theresa E Rodgers verfasserin aut Heather Lin verfasserin aut Maria E Suarez-Almazor verfasserin aut Faisal Fa’ak verfasserin aut Chantal Saberian verfasserin aut Cassian Yee verfasserin aut Michael A Davies verfasserin aut Sudhakar Tummala verfasserin aut Karin Woodman verfasserin aut Noha Abdel-Wahab verfasserin aut Adi Diab verfasserin aut In Journal for ImmunoTherapy of Cancer BMJ Publishing Group, 2013 7(2019), 1, Seite 11 (DE-627)750086335 (DE-600)2719863-7 20511426 nnns volume:7 year:2019 number:1 pages:11 https://doi.org/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db kostenfrei http://link.springer.com/article/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/toc/2051-1426 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2019 1 11
spelling	10.1186/s40425-019-0774-y doi (DE-627)DOAJ03538963X (DE-599)DOAJe15faeb18fd048fe83f36c7b0f6564db DE-627 ger DE-627 rakwb eng RC254-282 Houssein Safa verfasserin aut Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients. Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Daniel H Johnson verfasserin aut Van Anh Trinh verfasserin aut Theresa E Rodgers verfasserin aut Heather Lin verfasserin aut Maria E Suarez-Almazor verfasserin aut Faisal Fa’ak verfasserin aut Chantal Saberian verfasserin aut Cassian Yee verfasserin aut Michael A Davies verfasserin aut Sudhakar Tummala verfasserin aut Karin Woodman verfasserin aut Noha Abdel-Wahab verfasserin aut Adi Diab verfasserin aut In Journal for ImmunoTherapy of Cancer BMJ Publishing Group, 2013 7(2019), 1, Seite 11 (DE-627)750086335 (DE-600)2719863-7 20511426 nnns volume:7 year:2019 number:1 pages:11 https://doi.org/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db kostenfrei http://link.springer.com/article/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/toc/2051-1426 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2019 1 11
allfields_unstemmed	10.1186/s40425-019-0774-y doi (DE-627)DOAJ03538963X (DE-599)DOAJe15faeb18fd048fe83f36c7b0f6564db DE-627 ger DE-627 rakwb eng RC254-282 Houssein Safa verfasserin aut Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients. Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Daniel H Johnson verfasserin aut Van Anh Trinh verfasserin aut Theresa E Rodgers verfasserin aut Heather Lin verfasserin aut Maria E Suarez-Almazor verfasserin aut Faisal Fa’ak verfasserin aut Chantal Saberian verfasserin aut Cassian Yee verfasserin aut Michael A Davies verfasserin aut Sudhakar Tummala verfasserin aut Karin Woodman verfasserin aut Noha Abdel-Wahab verfasserin aut Adi Diab verfasserin aut In Journal for ImmunoTherapy of Cancer BMJ Publishing Group, 2013 7(2019), 1, Seite 11 (DE-627)750086335 (DE-600)2719863-7 20511426 nnns volume:7 year:2019 number:1 pages:11 https://doi.org/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db kostenfrei http://link.springer.com/article/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/toc/2051-1426 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2019 1 11
allfieldsGer	10.1186/s40425-019-0774-y doi (DE-627)DOAJ03538963X (DE-599)DOAJe15faeb18fd048fe83f36c7b0f6564db DE-627 ger DE-627 rakwb eng RC254-282 Houssein Safa verfasserin aut Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients. Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Daniel H Johnson verfasserin aut Van Anh Trinh verfasserin aut Theresa E Rodgers verfasserin aut Heather Lin verfasserin aut Maria E Suarez-Almazor verfasserin aut Faisal Fa’ak verfasserin aut Chantal Saberian verfasserin aut Cassian Yee verfasserin aut Michael A Davies verfasserin aut Sudhakar Tummala verfasserin aut Karin Woodman verfasserin aut Noha Abdel-Wahab verfasserin aut Adi Diab verfasserin aut In Journal for ImmunoTherapy of Cancer BMJ Publishing Group, 2013 7(2019), 1, Seite 11 (DE-627)750086335 (DE-600)2719863-7 20511426 nnns volume:7 year:2019 number:1 pages:11 https://doi.org/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db kostenfrei http://link.springer.com/article/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/toc/2051-1426 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2019 1 11
allfieldsSound	10.1186/s40425-019-0774-y doi (DE-627)DOAJ03538963X (DE-599)DOAJe15faeb18fd048fe83f36c7b0f6564db DE-627 ger DE-627 rakwb eng RC254-282 Houssein Safa verfasserin aut Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients. Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens Daniel H Johnson verfasserin aut Van Anh Trinh verfasserin aut Theresa E Rodgers verfasserin aut Heather Lin verfasserin aut Maria E Suarez-Almazor verfasserin aut Faisal Fa’ak verfasserin aut Chantal Saberian verfasserin aut Cassian Yee verfasserin aut Michael A Davies verfasserin aut Sudhakar Tummala verfasserin aut Karin Woodman verfasserin aut Noha Abdel-Wahab verfasserin aut Adi Diab verfasserin aut In Journal for ImmunoTherapy of Cancer BMJ Publishing Group, 2013 7(2019), 1, Seite 11 (DE-627)750086335 (DE-600)2719863-7 20511426 nnns volume:7 year:2019 number:1 pages:11 https://doi.org/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db kostenfrei http://link.springer.com/article/10.1186/s40425-019-0774-y kostenfrei https://doaj.org/toc/2051-1426 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2019 1 11
language	English
source	In Journal for ImmunoTherapy of Cancer 7(2019), 1, Seite 11 volume:7 year:2019 number:1 pages:11
sourceStr	In Journal for ImmunoTherapy of Cancer 7(2019), 1, Seite 11 volume:7 year:2019 number:1 pages:11
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens
isfreeaccess_bool	true
container_title	Journal for ImmunoTherapy of Cancer
authorswithroles_txt_mv	Houssein Safa @@aut@@ Daniel H Johnson @@aut@@ Van Anh Trinh @@aut@@ Theresa E Rodgers @@aut@@ Heather Lin @@aut@@ Maria E Suarez-Almazor @@aut@@ Faisal Fa’ak @@aut@@ Chantal Saberian @@aut@@ Cassian Yee @@aut@@ Michael A Davies @@aut@@ Sudhakar Tummala @@aut@@ Karin Woodman @@aut@@ Noha Abdel-Wahab @@aut@@ Adi Diab @@aut@@
publishDateDaySort_date	2019-01-01T00:00:00Z
hierarchy_top_id	750086335
id	DOAJ03538963X
language_de	englisch
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Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). 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callnumber-first	R - Medicine
author	Houssein Safa
spellingShingle	Houssein Safa misc RC254-282 misc Myasthenia gravis misc Immune checkpoint inhibitors misc Nivolumab misc Pembrolizumab misc Ipilimumab misc Immunotherapy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
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topic_title	RC254-282 Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature Myasthenia gravis Immune checkpoint inhibitors Nivolumab Pembrolizumab Ipilimumab Immunotherapy
topic	misc RC254-282 misc Myasthenia gravis misc Immune checkpoint inhibitors misc Nivolumab misc Pembrolizumab misc Ipilimumab misc Immunotherapy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc RC254-282 misc Myasthenia gravis misc Immune checkpoint inhibitors misc Nivolumab misc Pembrolizumab misc Ipilimumab misc Immunotherapy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_browse	misc RC254-282 misc Myasthenia gravis misc Immune checkpoint inhibitors misc Nivolumab misc Pembrolizumab misc Ipilimumab misc Immunotherapy misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
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title_full	Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
author_sort	Houssein Safa
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author_browse	Houssein Safa Daniel H Johnson Van Anh Trinh Theresa E Rodgers Heather Lin Maria E Suarez-Almazor Faisal Fa’ak Chantal Saberian Cassian Yee Michael A Davies Sudhakar Tummala Karin Woodman Noha Abdel-Wahab Adi Diab
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title_sort	immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
callnumber	RC254-282
title_auth	Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
abstract	Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients.
abstractGer	Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients.
abstract_unstemmed	Abstract Background Myasthenia gravis (MG) is a rare but life-threatening adverse event of immune checkpoint inhibitors (ICI). Given the limited evidence, data from a large cohort of patients is needed to aid in recognition and management of this fatal complication. Methods We reviewed our institutional databases to identify patients who had cancer and MG in the setting of ICI. We systematically reviewed the literature through August 2018 to identify all similar reported patients. We collected data on clinical and diagnostic features, management, and outcomes of these cases. Results Sixty-five patients were identified. Median age was 73 years; 42 (65%) were males, 31 (48%) had metastatic melanoma, and 13 (20%) had a preexisting MG before ICI initiation. Most patients received anti-PD-1 (82%). Sixty-three patients (97%) developed ICI-related MG (new onset or disease flare) after a median of 4 weeks (1 to 16 weeks) of ICI initiation. Twenty-four patients (37%) experienced concurrent myositis, and respiratory failure occurred in 29 (45%). ICI was discontinued in 61 patients (97%). Death was reported in 24 patients (38%); 15 (23%) due to MG complication. A better outcome was observed in patients who received intravenous immunoglobulin (IVIG) or plasmapheresis (PLEX) as first-line therapy than in those who received steroids alone (95% vs 63% improvement of MG symptoms, p = 0.011). Conclusions MG is a life-threatening adverse event of acute onset and rapid progression after ICI initiation. Early use of IVIG or PLEX, regardless of initial symptoms severity, may lead to better outcomes than steroids alone. Our data suggest the need to reassess the current recommendations for management of ICI-related MG until prospective longitudinal studies are conducted to establish the ideal management approach for these patients.
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title_short	Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature
url	https://doi.org/10.1186/s40425-019-0774-y https://doaj.org/article/e15faeb18fd048fe83f36c7b0f6564db http://link.springer.com/article/10.1186/s40425-019-0774-y https://doaj.org/toc/2051-1426
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author2Str	Daniel H Johnson Van Anh Trinh Theresa E Rodgers Heather Lin Maria E Suarez-Almazor Faisal Fa’ak Chantal Saberian Cassian Yee Michael A Davies Sudhakar Tummala Karin Woodman Noha Abdel-Wahab Adi Diab
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Immune checkpoint inhibitor related myasthenia gravis: single center experience and systematic review of the literature

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