Proteasome inhibitors for malignancy-related Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disease characterized by proximal muscle weakness, loss of tendon reflexes, and autonomic dysfunction. Muscle weakness usually starts in the upper legs and can progress to oculobulbar and in severe cases respiratory muscles. P/Q-type voltage-gated calcium channels (VGCCs) localized in the presynaptic motor nerve terminal and in the autonomic nervous system are targeted by antibodies in LEMS patients. These antibodies can be detected in about 90% of patients, and the presence of decrement and increment upon repetitive nerve stimulation is also a highly sensitive diagnostic test. Rapid diagnosis is important because of the association with SCLC in 50%-60% of patients, which stresses the need for vigorous tumor screening after diagnosis. Clinical parameters can predict tumor probability and guide frequency of tumor screening. Treatment of the tumor as well as symptomatic treatment and immunosuppression can effectively control symptoms in the majority of patients.

The future of immunotherapy in the treatment of lung cancer

SUMMARY 

Despite advances in the understanding of the genetic and nongenetic mechanisms involved in driving the development of lung cancers, mortality from lung cancer remains very poor. Detection and recognition of pathogens as being foreign and the facilitation of their destruction is the fundamental role of the immune system. Recent approval for the use of immunotherapeutics in the treatment of melanoma and prostate cancer, and emerging evidence of the interplay between malignant cells and the host immune response in recognizing them have led to a new focus in the treatment of lung cancer. Such strategies include vaccination therapies and immune checkpoint blockade, many of which have reached Phase III trials but with modest translation to clinical benefit. This article looks at the biology and current clinical data in the use of these immunological agents.