{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:04:22Z","timestamp":1753877062290,"version":"3.41.2"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T00:00:00Z","timestamp":1645315200000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>We report on a 79-year-old man diagnosed with localized Merkel cell carcinoma (MCC) who also had acetylcholine receptor antibody (Ach-R-Ab)-positive myasthenia gravis (MG) controlled on prednisolone, mycophenolate and intravenous immunoglobulin (IVIG). His MCC was initially treated with radiation, followed by chemotherapy on metastatic recurrence. Chemotherapy initially stabilized the disease, but he experienced significant fatigue and his disease progressed within 3 months. After careful consideration of the risk of a myasthenic crisis, he was commenced on avelumab. He had initial partial response, though he ultimately developed progressive disease which led to a decision for best supportive care at 10\u00a0months post starting immunotherapy. Importantly, as per spirometry, his MG remained stable throughout immunotherapy. We present the current case to demonstrate that MG should not be viewed as an absolute contraindication to immunotherapy in scenarios where there are limited alternate therapeutic options.<\/jats:p>","DOI":"10.1093\/omcr\/omac012","type":"journal-article","created":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T07:08:48Z","timestamp":1645340928000},"source":"Crossref","is-referenced-by-count":1,"title":["Outcome of patient with myasthenia gravis with the use of immunotherapy in metastatic Merkel cell carcinoma"],"prefix":"10.1093","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4037-2779","authenticated-orcid":false,"given":"Sarah","family":"Williams","sequence":"first","affiliation":[{"name":"Medical Oncology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Liang","sequence":"additional","affiliation":[{"name":"Neurology, Royal North Shore Hospital, St. Leonards, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Guminski","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Hruby","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Royal North Shore Hospital, St. Leonards, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Chan","sequence":"additional","affiliation":[{"name":"Medical Oncology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,19]]},"reference":[{"key":"2022022007083902800_ref1","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1002\/cam4.815","article-title":"Response rates and durability of chemotherapy among 62 patients with metastatic Merkel cell carcinoma","volume":"5","author":"Iyer","year":"2016","journal-title":"Cancer Med"},{"key":"2022022007083902800_ref2","doi-asserted-by":"crossref","DOI":"10.1136\/jitc-2020-000674","article-title":"Avelumab in patients with previously treated metastatic Merkel cell carcinoma: long-term data and biomarker analyses from the single-arm phase 2 JAVELIN Merkel 200 trial","volume":"8","author":"D'Angelo","year":"2020","journal-title":"J Immunother Cancer"},{"key":"2022022007083902800_ref3","doi-asserted-by":"crossref","first-page":"161","DOI":"10.21037\/jgo.2018.09.19","article-title":"Complete response to pembrolizumab in a patient with metastatic colon cancer with microsatellite instability and a history of Guillain-Barre syndrome","volume":"10","author":"Wang","year":"2019","journal-title":"J Gastrointest Oncol"},{"key":"2022022007083902800_ref4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.cellimm.2016.09.009","article-title":"PD-1\/PD-L and autoimmunity: a growing relationship","volume":"310","author":"Zamani","year":"2016","journal-title":"Cell Immunol"},{"key":"2022022007083902800_ref5","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ejca.2017.05.041","article-title":"Myasthenia gravis: an emerging toxicity of immune checkpoint inhibitors","volume":"82","author":"Makarious","year":"2017","journal-title":"Eur J Cancer"},{"key":"2022022007083902800_ref6","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s40425-019-0626-9","article-title":"Metastatic Merkel cell carcinoma and myasthenia gravis: contraindication for therapy with immune checkpoint inhibitors?","volume":"7","author":"Zaremba","year":"2019","journal-title":"J Immunother Cancer"},{"key":"2022022007083902800_ref7","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/mus.25141","article-title":"Exacerbation of myasthenia gravis in a patient with melanoma treated with pembrolizumab","volume":"54","author":"Lau","year":"2016","journal-title":"Muscle Nerve"},{"key":"2022022007083902800_ref8","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3233\/JND-170219","article-title":"Severe exacerbation of myasthenia gravis associated with checkpoint inhibitor immunotherapy","volume":"4","author":"Cooper","year":"2017","journal-title":"J Neuromusc Dis"},{"key":"2022022007083902800_ref9","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/annonc\/mdw443","article-title":"Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab","volume":"28","author":"Menzies","year":"2017","journal-title":"Ann Oncol"},{"key":"2022022007083902800_ref10","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1200\/JCO.2018.79.0006","article-title":"Impact of baseline steroids on efficacy of programmed cell death-1 and programmed death-ligand 1 blockade in patients with non\u2013small-cell lung cancer","volume":"36","author":"Ferrara","year":"2018","journal-title":"J Clin Oncol"}],"container-title":["Oxford Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2022\/2\/omac012\/42558772\/omac012.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2022\/2\/omac012\/42558772\/omac012.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,20]],"date-time":"2022-02-20T07:08:57Z","timestamp":1645340937000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/omcr\/article\/doi\/10.1093\/omcr\/omac012\/6532296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,1]]},"references-count":10,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/omcr\/omac012","relation":{},"ISSN":["2053-8855"],"issn-type":[{"type":"electronic","value":"2053-8855"}],"subject":[],"published-other":{"date-parts":[[2022,2]]},"published":{"date-parts":[[2022,2,1]]},"article-number":"omac012"}}