Myositis/myasthenia after pembrolizumab in a bladder cancer patient with an autoimmunity-associated HLA: Immune

6533b82dfe1ef96bd1291de1

RESEARCH PRODUCT

Myositis/myasthenia after pembrolizumab in a bladder cancer patient with an autoimmunity-associated HLA: Immune–biological evaluation and case report

Roberto Maisano Giovanna Orizzonte Giorgio Restifo Pierpaolo Correale Michele Caraglia Vincenzo Dattola Cirino Botta Rita Agostino Rita Emilena Saladino Domenico Mazzacuva Rocco Giannicola Antonia Consuelo Falzea Natale Daniele Calandruccio Antonino Mafodda Umberto Aguglia 1 Giovanna Bianco Eleonora Iuliano Vittoria Cianci

subject

0301 basic medicine Oncology Male Case Report Autoimmunity Pembrolizumab PD1-checkpoint inhibitors medicine.disease_cause Autoimmunity 0302 clinical medicine Antineoplastic Agents Immunological Biology (General)HLA Antigen Myositi PD1-checkpoint inhibitor Spectroscopy Myositis General Medicine Computer Science Applications Myasthenia Gravi Chemistry Pyridostigmine urothelial cancer 030220 oncology & carcinogenesis Urinary Bladder Neoplasm Class-I/II HLA Myasthenia medicine.drug Human medicine.medical_specialty QH301-705.5 Prognosi Human leukocyte antigen Antibodies Monoclonal Humanized Catalysis Inorganic Chemistry 03 medical and health sciences Internal medicine medicine Physical and Theoretical Chemistry Adverse effect Molecular Biology QD1-999 Aged business.industry Organic Chemistry Cancer medicine.disease Discontinuation 030104 developmental biology business

description

Pembrolizumab (mAb to PD-1) has been recently approved for the therapy of pretreated urothelial cancer. Despite the efficacy, it is often accompanied by unpredictable and sometime severe immune-related (ir) adverse events (AEs). Here, we report the clinical and immune–biological characterization of a patient with a metastatic bladder cancer who developed myositis signs (M) and a myasthenia-like syndrome (MLS) during treatment with pembrolizumab. The patient presented an autoimmunity-associated HLA haplotype (HLA-A*02/HLA-B*08/HLA-C*07/HLA-DRB1*03) and experienced an increase in activated CD8 T-cells along the treatment. The symptomatology regressed after pembrolizumab discontinuation and a pyridostigmine and steroids-based therapy. This is the first report of concurrent M and MLS appearance in cancer patients receiving pembrolizumab. More efforts are needed to define early the risk and the clinical meaning of irAEs in this setting.

year	journal	country	edition	language
2021-06-01

10.3390/ijms22126246 http://hdl.handle.net/11591/462420