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Neuromuscular Complications of Programmed Cell Death-1 (PD-1) Inhibitors

Current Neurology and Neuroscience Reports volume 18, Article number: 63 (2018) Cite this article

Abstract

Purpose of Review

In recent years, immune checkpoint inhibitors have been increasingly used in patients with metastatic cancers with favorable oncological outcomes; however, there have also been increasing number of cancer survivors who have developed immune-related adverse events. Little is known about PD-1 inhibitor-associated neuromuscular complications.

Recent Findings

Neuromuscular disorders are the most common neurological complication reported in PD-1 inhibitor-treated patients. Myasthenia gravis, immune-mediated myopathies, and Guillain-Barre syndrome are among commonly reported immune-related neuromuscular complications. HyperCKemia occurs frequently in patients with PD-1 inhibitor-associated myasthenia gravis, indicating coexisting myopathies or myocarditis. Oculobulbar weakness is a unique and common presentation of PD-1 inhibitor-associated immune-mediated myopathies with or without concomitant myasthenia gravis. High-dose steroid monotherapy may be associated with clinical deterioration in some patients with PD-1 inhibitor-associated myasthenia gravis, immune-mediated myopathies, or Guillain-Barre syndrome.

Summary

PD-1 inhibitor-associated neuromuscular complications have some characteristic features compared to their idiopathic counterparts. Although steroid monotherapy is commonly used in non-neuromuscular autoimmune disorders triggered by anti-PD-1 therapy, this may lead to unfavorable outcomes in some patients with PD-1 inhibitor-associated neuromuscular complications.

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Affiliations

  1. Department of Neurology, Auckland City Hospital, Auckland, New Zealand

    Justin C. Kao

  2. Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Adipong Brickshawana

  3. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

    Teerin Liewluck

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  1. Justin C. Kao
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  2. Adipong Brickshawana
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  3. Teerin Liewluck
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Correspondence to Teerin Liewluck.

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Justin C. Kao, Adipong Brickshawana, and Teerin Liewluck declare no conflict of interest.

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Kao, J.C., Brickshawana, A. & Liewluck, T. Neuromuscular Complications of Programmed Cell Death-1 (PD-1) Inhibitors. Curr Neurol Neurosci Rep 18, 63 (2018). https://doi.org/10.1007/s11910-018-0878-7

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Keywords

  • Myasthenia gravis
  • Myositis
  • Neuropathy
  • Nivolumab
  • Pembrolizumab
  • Programmed cell death-1 (PD-1) inhibitors