title: Nivolumab for the treatment of malignant melanoma in a patient with pre-existing myasthenia gravis.
abstract: A 79-year-old man with lymph node recurrence of malignant melanoma received nivolumab, an anti-programmed death 1 (PD-1) monoclonal antibody. He had pre-existing ocular myasthenia gravis (MG) and a continued small amount of corticosteroid. Grade 3 creatine phosphokinase elevation appeared after two doses of nivolumab, and the treatment was postponed until it improved to grade 1. After three doses of nivolumab, he experienced diplopia and facial muscle weakness which were consistent with an acute exacerbation of MG, and the symptoms relieved without additional treatment for MG. He achieved shrinkage of metastasis after ten doses of nivolumab. Although a case who died due to MG after administration of nivolumab was reported recently, pre-existing MG is considered not to be always a contraindication of nivolumab.
authors.affiliation: Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Maeda
authors.affiliation: Department of Dermatology, Nagoya University Graduate School of Medicine Nagoya, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokota
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine Nagoya, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Atsuta
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine Nagoya, Japan.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Katsuno
authors.affiliation: Department of Dermatology, Nagoya University Graduate School of Medicine Nagoya, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Akiyama
authors.affiliation: Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ando
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D006801:Humans; D008297:Male; D008545:Melanoma; D009157:Myasthenia Gravis; D000077594:Nivolumab; D012878:Skin Neoplasms
chemical_list: D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077594:Nivolumab
keywords: anti-programmed death 1 (PD-1) monoclonal antibody; creatine phosphokinase; malignant melanoma; myasthenia gravis; nivolumab