Dr Iams on the Optimal Management of LEMS in Patients With SCLC

“Treating the underlying cancer is first and foremost part of the treatment. These patients should still proceed on our standard SCLC treatment paradigm. But the key addition, if a patient has SCLC-associated LEMS, is treatment with amifampridine, which is an FDA-approved oral therapy that helps decrease the symptoms of LEMS.”

Wade Iams, MD, MSCI, director of Lung Cancer Research, Greco Hainsworth Centers for Research, Tennessee Oncology, discussed the management of Lambert-Eaton myasthenic syndrome (LEMS) in the context of small cell lung cancer (SCLC), emphasizing that treatment should address both the underlying malignancy and the associated paraneoplastic syndrome.

As with most paraneoplastic syndromes, the cornerstone of management remains effective treatment of the primary cancer, Iams said. Patients with SCLC-associated LEMS should proceed with standard-of-care systemic therapy for their malignancy, because controlling tumor burden can help mitigate paraneoplastic manifestations. However, Iams noted that this approach alone is often insufficient to fully address the neurologic symptoms associated with LEMS, necessitating additional intervention.

A key component of management in this setting is the use of amifampridine (Firdapse), an FDA-approved oral therapy specifically indicated for the treatment of LEMS. This agent works by enhancing neuromuscular transmission, thereby improving the hallmark symptoms of the condition. Clinical data from randomized studies have demonstrated that amifampridine can lead to meaningful improvements in muscle strength and overall quality of life, particularly by alleviating muscle weakness and symptoms of autonomic dysfunction, or dysautonomia, which are commonly observed in affected patients.

Iams underscored that incorporating amifampridine into the treatment plan can provide symptomatic relief that complements ongoing cancer-directed therapy. This dual approach of targeting both the malignancy and the neurologic syndrome can be especially impactful for patients whose daily functioning is significantly impaired by LEMS-related weakness.

In clinical practice, the benefits of this strategy are evident. Iams cited firsthand experience with a patient who experienced notable improvement in LEMS symptoms following initiation of amifampridine in the setting of SCLC. Such outcomes highlight the importance of recognizing paraneoplastic syndromes early and initiating appropriate supportive therapies alongside standard oncologic care.