Severe Exacerbation of Myasthenia Gravis Associated with Checkpoint Inhibitor Immunotherapy (P6.450)

Objective: Not applicable Background: Monoclonal antibodies that target either PD-1 or PD-L1 have recently been approved for treatment of advanced non-small cell lung cancer. These antibodies are immune checkpoint inhibitors which have been shown to exacerbate Myasthenia Gravis (MG) and other autoimmune diseases. While effective in preventing tumor cells from evading immune attack, immune checkpoint inhibitors such as nivolumab, an antibody directed against the programmed cell death protein-1 (PD-1) receptor located on T-cells, may also cause immune dysregulation and could cause or potentiate pre-existing autoimmune conditions. Design/Methods: Not applicable Results: We present a patient with latent ocular MG treated with nivolumab for her stage IV non-small cell lung cancer who developed generalized MG and severe myasthenic crisis. Conclusions: Providers must be aware of the risks inherent to these novel therapies since they can have life-threatening effects. Disclosure: Dr. Cooper has nothing to disclose. Dr. Meriggioli has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis. Dr. Bonomi has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Astra Zeneca, Biodesix, Bristol Myers Squibb, Clovis, Helsinn Pharmaceuticals, Imedex, Eli Lilly, Merck, Pfizer, Roche-Genentech, and Spectrum Pharmaceuticals. Dr. Malik has nothing to disclose.