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Abstract Details

Neuromuscular complications of Immune checkpoint inhibitors.
Neuromuscular and Clinical Neurophysiology (EMG)
Neuromuscular and Clinical Neurophysiology (EMG) Posters (7:00 AM-5:00 PM)
127
To identify the neuromuscular complications associated with the use of immune checkpoint inhibitor therapy at the University of Kansas Medical Center.
Immune checkpoint proteins including cytotoxic T-lymphocyte antigen -4, CTLA-4 and programmed cell death protein-1, PD-1 are located on the membrane of T cells which bind to their ligands B7-1/B7-2 and PD-L1 respectively located on antigen presenting cells to keep the T cells from killing tumor cells. Blocking these bindings by immune checkpoint inhibitors (ICPIs) allows the T cells to kill tumor cells. Although this has become an important therapy for certain advanced cancers, neuromuscular complications have been reported with these therapies. 

Following IRB approval, we conducted a search of the Neuromuscular division database and an enterprise-wide database for the entire health system for patients on ICPIs therapy who developed neuromuscular complications. We abstracted demographic and clinical data.

 
Total 3 patients were identified to date and charts review is still ongoing. The age of the patients was 72, 63, 66 years, all were male . ICPIs were used for metastatic renal cell carcinoma, bladder cancer and melanoma respectively. Patients presented with weakness in the extremities, respiratory and bulbar muscles. The time of symptom onset from ICPIs therapy was 4± 1.7 months. Clinically first two patients were diagnosed as having myositis. In both cases, electrodiagnostic testing showed irritative myopathy, muscle biopsy showed necrotizing myopathy, and they responded to  IVIG and corticosteroids steroid therapy. The 3rd patient was initially diagnosed as having neuromuscular junction disorder and later confirmed as having myositis. He did not have muscle biopsy due to his medical conditions and did not respond to multiple therapies. ICPIs were stopped in all.
ICPIs are associated predominantly with necrotizing myopathy in our small case series. Retrospective data abstraction is ongoing. We plan to present the full dataset at the Â鶹´«Ã½Ó³»­ annual meeting.
Authors/Disclosures
Mohammed W. Rahman, DO (NorthWell University Medical Center)
PRESENTER 		Dr. Rahman has nothing to disclose.
Constantine Farmakidis, MD, FÂ鶹´«Ã½Ó³»­ Dr. Farmakidis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Farmakidis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for J&J. Dr. Farmakidis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Muscular Dystrophy Association.
Omar Jawdat, MD (The University of Kansas Medical Center) Dr. Jawdat has nothing to disclose.
Duaa Jabari, MD (The University of Kansas Medical Center) Dr. Jabari has nothing to disclose.
Nathan McGraw, MD (St. Luke's Physician Group) Dr. McGraw has nothing to disclose.
Swathy Chandrashekhar, MD (University of Kansas Medical Center) Dr. Chandrashekhar has received publishing royalties from a publication relating to health care.
Mazen M. Dimachkie, MD, FÂ鶹´«Ã½Ó³»­ (University of Kansas Medical Center) Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Octapharma. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ArgenX. Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for Catalyst. Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for Takeda. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medlink. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSL Behring. Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for Astellas. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Janssen. Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Dianthus. Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for TACT / Treat NMD. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cabaletta Bio. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Clinical Neurological Society of America, Inc . Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for Ig Society, Inc. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abcuro. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amicus. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon/Immunovant. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nuvig. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Â鶹´«Ã½Ó³»­ (Â鶹´«Ã½Ó³»­). Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for American Association of Neuromuscular and Electrodiagnostic Medicine (Â鶹´«Ã½Ó³»­EM). Dr. Dimachkie has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Annexon Biosciences. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AstraZeneca. Dr. Dimachkie has received personal compensation in the range of $0-$499 for serving as a Consultant for Candid Therapeutics. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Creyon Bio, Inc.. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nuvig Therapeutics. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB Biopharma. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Vertex Pharmaceuticals. Dr. Dimachkie has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fortrea. Dr. Dimachkie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kriya Therapeutics. The institution of Dr. Dimachkie has received research support from NIH. The institution of Dr. Dimachkie has received research support from The Myositis Association. The institution of Dr. Dimachkie has received research support from Biosensics. Dr. Dimachkie has received intellectual property interests from a discovery or technology relating to health care. Dr. Dimachkie has received intellectual property interests from a discovery or technology relating to health care. Dr. Dimachkie has received intellectual property interests from a discovery or technology relating to health care. Dr. Dimachkie has received publishing royalties from a publication relating to health care. Dr. Dimachkie has received publishing royalties from a publication relating to health care.
Mamatha Pasnoor, MD, FÂ鶹´«Ã½Ó³»­ Dr. Pasnoor has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Argenx BVBA. Dr. Pasnoor has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen Pharmaceutical. Dr. Pasnoor has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Immunovant. Dr. Pasnoor has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pasnoor has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Pasnoor has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Grifols. Dr. Pasnoor has received personal compensation in the range of $500-$4,999 for serving as a Consultant for amgen.