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Lambert-Eaton Myasthenic Syndrome in Small-Cell Lung Cancer: Bridging Oncology and Neurology to Achieve Earlier Diagnostics and Coordinated Care

Lambert-Eaton Myasthenic Syndrome in Small-Cell Lung Cancer: Bridging Oncology and Neurology to Achieve Earlier Diagnostics and Coordinated Care

Dr. Misty Shields from Indiana University moderated a discussion with Dr. Ditte Primdahl, neuro-oncologist at Northwestern University, and Dr. Triparna Sen from The Ohio State University Comprehensive Cancer Center on cancer-associated Lambert-Eaton myasthenic syndrome (CA LEMS) in small cell lung cancer (SCLC). CA LEMS is a paraneoplastic neuromuscular junction disorder characterized by proximal muscle weakness, hyporeflexia, and autonomic dysfunction, arising from autoantibodies against presynaptic voltage-gated calcium channels (VGCCs). Despite estimated prevalence of 3% to 6% in SCLC, CA LEMS is diagnosed in under 1% of patients in real-world practice. The program addresses clinical recognition, differential diagnosis from treatment-related toxicities, VGCC antibody testing including seronegative cases, electrodiagnostic studies, the 2025 NCCN guideline update, amifampridine (Firdapse) as FDA-approved symptomatic treatment, immune checkpoint inhibitor safety considerations, and optimal multidisciplinary care models. Evidence gaps including prospective prevalence data, immune checkpoint inhibitor safety in CA LEMS, and validated patient-reported outcome instruments are identified as priority research needs.

Lambert-Eaton Myasthenic Syndrome in Small-Cell Lung Cancer: Bridging Oncology and Neurology to Achieve Earlier Diagnostics and Coordinated Care

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3 experts are featured in this series

EP. 2: Recognizing CA LEMS in Small Cell Lung Cancer: Clinical Features, the Classic Triad, and Cancer Screening Before Diagnosis

ByMisty D. Shields, MD, PhD,Ditte Primdahl, MD,Triparna Sen, PhD

Dr. Primdahl describes what CA LEMS looks like clinically for oncologists with limited exposure to this diagnosis. Patients are unlikely to self-report proximal weakness in clinical terms; they more commonly describe difficulty with everyday tasks, such as climbing stairs, getting in and out of a car or chair.