When Lambert-Eaton myasthenic syndrome (LEMS) occurs alongside an associated malignancy, it presents a distinct paraneoplastic scenario requiring a carefully structured immunotherapeutic approach that accounts for the interaction between neurological treatment and ongoing oncological management.
This protocol addresses LEMS arising in the context of an associated malignancy. LEMS can be idiopathic — mostly in women younger than 50 years — or, less commonly, as a paraneoplastic disease, particularly in small-cell lung cancer (SCLC) and predominantly in long-time smokers. The paraneoplastic form shapes both the immunotherapeutic strategy and the timing decisions around treatment.
The approach centres on glucocorticosteroids as a foundational immunotherapeutic agent, combined with a steroid-sparing agent — the complete dosing algorithm, sequencing, and guidance on when immunotherapy may be deferred relative to chemotherapy are detailed in the full protocol.
During therapy, an absolute lymphocyte count of 600–1000/μl is the key monitoring target. The full protocol specifies how this informs dose adjustment and ongoing management.
DOI: 10.1177/17562864231213240