Myastenic Syndrome Diagnosed After Treatment of Small Cell Lung Cancer with Atezolizumab (PDL-1 Inhibitor)

Immune checkpoint inhibitors have been increasingly used for many type of solid tumor, first line treatment of small cell lung cancer (SCLC) with chemotherapy combination with atezolizumab is one of them. Although usually well tolerated, autoimmune related side effects can be seen.We report of autoimmune myasetnia gravis that occured after treatment of atezolizumab, an anti-programmed-death (anti-PD-1) monoclonal antibody.
Our patient is 71 year old woman with extensive stage small cell lung cancer receiving chemotherapy combined with atezolizumab. Although good oncological response to treatment after 8 cycle of atezolizumab, myastenia gravis was occured. This automimmune neurological syndrome is likely associated with atezolizumab treatment, patient had no any neurological disorder before. Symptoms were partially responded after steroid, piridostigmine and iv-ig therapy.
The number of the patient that treated with immunotherapy will increase in the future so it should be important to know the adverse effects management of immunotherapy.