Nivolumab-induced Lambert-Eaton myasthenic syndrome: an immune-related adverse event in nonsmall cell lung cancer

Abstract

Nivolumab is an anti-programmed cell death protein 1 (anti-PD-1) monoclonal antibody and was the first immune checkpoint inhibitor drug approved for use in advanced non-small cell lung cancer (NSCLC). In this report, we describe a rare case of Lambert-Eaton myasthenic syndrome (LEMS), which developed as a side effect of nivolumab in a patient with metastatic lung squamous cell carcinoma. Our patient, who was previously treated with nivolumab for metastatic squamous cell carcinoma of the lung, appeared with a headache, swollen face, dysarthria, asthenia, xerostomia, and drooping eyelid. Early testing indicated no thymomas or newly developing tumors in whole-body scans, and the blood workup was normal. We came to the conclusion that nivolumab-induced LEMS was the cause of the symptoms after performing nerve conduction investigations ruling out other differentials. We believe our clinical experience of this rare and unexpected adverse event should be shared.

Keywords:

• Nivolumab
• non-small cell lung cancer
• Lambert-Eaton myasthenic syndrome
• drug side effect
• immunotherapy
• anti-cancer

Acknowledgements

The authors would like to thank Dr. Naveeduddin Ahmed, and his neurology team as they were involved in our patient care and treatment.

Authors’ contributions

Syed Tabish Rehman- Conceptualization, Project administration, Writing – original draft writing – review & editing. Syeda Mahnoor Azeem- Project administration, Data curation, Writing – original draft, Review & Editing. Areeba Akbar- Data curation, Writing – original draft, Review & Editing. Omer Shafiq- Data curation, Resources, Writing – original draft. Syed Shehryar Azeem- Methodology, Data Curation, Writing. Shabbir Hussain A. Ali- Supervision, Writing – review, Project administration, and Maintaining report integrity and guarantor.

Disclosure statement

None declared.

Funding

No funding was required for the case report.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article. Specifics can be requested from the corresponding author, Ali SH.

Consent for publication

Informed written consent was obtained from the patient for publication of this case. Consent is available on request.

Ethics approval and consent to participate

Ethical approval was granted.