I have a lovely yet unfortunate 77 yo woman who I diagnosed with ocular myasthenia and Graves 18 years ago. She has remained pure ocular, and was AB (-) Her course has been very mild.
She was recently diagnosed with metastatic renal cell Ca.
The issue of treatment with TKI +/- ICI therapy has come up. Of course if she had systemic MG we would expect a high risk of crashing.
Today's exam shows she has no signs of either Graves nor ocular MG (she often has been in clinical remission) off mestinon and off prednisone.
At her initial presentation with renal cell in 2015, about 6 years after I diagnosed the MG, she tolerated treatment with everolimus
Does anyone have any experience with long-term pure oculars being treated with these agents?
The oncologist is thinking of avoiding them.
Thanks