Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website https://www.journalmc.org

Case Report

Volume 14, Number 2, February 2023, pages 71-75

Durvalumab for Extensive-Stage of Small-Cell Lung Cancer With Lambert-Eaton Myasthenic Syndrome

Figures

Figure 1.
Figure 1. Chest CT before the initiation of treatment (a) and after two courses of treatment (b). White arrow indicates pretreatment left hilar lymphadenopathy. CT: computed tomography.
Figure 2.
Figure 2. Histopathological finding of endobronchial ultrasound-guided trans-bronchial needle aspiration biopsy from the right hilar lymph node (hematoxylin and eosin stain).
Figure 3.
Figure 3. Nerve conduction study showed 2.4-fold increase of CMAP amplitude after exercise (a). Repetitive nerve stimulation of the left ulnar nerve presented waning phenomenon with 3 Hz repetitive stimulation (b) and waxing phenomenon with 30 Hz repetitive stimulation (c). CMAP: compound muscle action potential.

Table

Table 1. Summary of Previous Cases of ICIs for Cancers With LEMS
 
Authors (year)Age/sexCancerICIsLEMS treatmentAnti-P/Q-type VGCC antibody (pmol/L)Outcomes
Pre-ICIsPost-ICIsLEMSCancer
CR: complete remission; 3,4-DAP: 3,4-diaminopyridine; ICI: immune checkpoint inhibitor; IVIG: intravenous immunoglobulin; LEMS: Lambert-Eaton myasthenic syndrome; MCC: Merkel cell carcinoma; mo: months; NA: not assessed; PD: progressive disease; PR: partial response; SCLC: small-cell lung cancer: SQ: squamous cell carcinoma.
Dohrn et al, 2020 [10]62/FMCCAvelumab3,4-DAP + pyridostigmine387.6NAExacerbatedCR
Sakaguchi et al, 2022 [8]56/MSCLCAtezolizumabNone> 30NAImprovedPD (5 mo)
Takigawa et al, 2022 [7]73/FLung SQPembrolizumabIVIG124.9NARecurredPR
Green et al, 2022 [9]67/MMCCAvelumab3,4-DAP + pyridostigmineUndetectableNAImprovedPR
Ours62/FSCLCDurvalumabPyridostigmine1,419.2263.4ImprovedPD (5 mo)