Myasthenia gravis induced by avelumab

Abstract

Neurological immune-related adverse events are potentially life-threatening complications of immune checkpoint inhibitors. Myasthenia gravis (MG) is a rare complication of treatment with inhibitors of programmed cell death protein 1 (PD)-1 and PD ligand 1 (PD-L1). We present a patient who developed seronegative MG resulting in respiratory failure while being treated with avelumab for metastatic, treatment-refractory ovarian cancer. Her MG went into remission following steroids and maintenance intravenous immunoglobulin treatment. We conclude that MG is a rare, but potentially life-threatening immune-related adverse event of avelumab therapy. This case provides support to the hypothesis that PD-1/PD-L1 signaling may have a protective role in MG.

Keywords::

• avelumab
• checkpoint inhibitor
• immune related adverse event
• irAE
• myasthenia gravis
• PD-L1

Author contributions

C Yuen, G Fleming, B Soliven, M Meyers and K Rezania collected and interpreted the dates and drafted the manuscript. All authors revised and approved the final submitted manuscript.

Financial & competing interests disclosures

The data presented in this report were gathered from a clinical trial sponsored by Syndax and supported by Pfizer and Merck KgaA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient/patients for the inclusion of their medical and treatment history within this case report.

Additional information

Funding

The data presented in this report were gathered from a clinical trial sponsored by Syndax and supported by Pfizer and Merck KgaA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.