Immune Checkpoint Inhibitors and Myasthenic Syndromes: A Case Report of a Metastatic Renal Cell Carcinoma Patient Treated With Nivolumab

摘要

Nivolumab is an immune checkpoint inhibitor (ICI), which strengthens T-cell immune responses (including antitumor responses)1 and it is indicated for treatment of many malignancies, including renal cell carcinoma. ICIs are associated with class-related side effects, called immune-related adverse events, which derive from an aberrant self-activation of T-cell immune response. Among immune-related adverse events are included neurological events such as myasthenia gravis and myasthenic syndromes,4 with a wide range of clinical expressions, from mild to severe forms. Many cases of nivolumab-induced myasthenia gravis were reported5 and these occurrences must be timely differentiated by paraneoplastic neurological syndromes, such as Lambert-Eaton myasthenic syndrome.