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In today’s episode, we had the pleasure of speaking with Jacob Sands, MD, and Shailee Shah, MD, about considerations for diagnosing and managing Lambert-Eaton myasthenic syndrome (LEMS), particularly in the context of small cell lung cancer (SCLC). Dr Sands is associate chief of the Lowe Center for Thoracic Oncology and the Oncology Medical Director of the International Patient Center at Dana-Farber Cancer Institute, as well as an assistant professor at Harvard Medical School in Boston, Massachusetts. Dr Shah is a clinical assistant professor of neurology (MS/neuroimmunology) at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. 

In our exclusive interview, Drs Sands and Shah discussed LEMS symptom identification, the importance of paraneoplastic panels for assessing neurologic dysfunction in patients with SCLC, the need for specific autoantibody testing, and what guidelines currently note as best practices for the diagnosis of this disease. 

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Podcasts

Drs Sands and Shah discuss LEMS symptom identification and what guidelines currently note as best practices for the diagnosis of this disease. 

Accurate Symptom Identification and Guidelines Support LEMS Screening and Diagnosis: With Jacob Sands, MD; and Shailee Shah, MD

Dr Leal on Clinical Considerations Surrounding the Diagnosis of LEMS in Patients With Lung Cancer

“As a medical oncologist, seeing patients with SCLC or [potentially] NSCLC, the critical thing is to think about the clinical presentation of LEMS. There needs to be awareness and education on the symptoms, because sometimes the symptoms can be vague at initial onset, and that can delay diagnosis or [lead to] misdiagnosis, especially in somebody with SCLC who may already have deconditioning.”

Ticiana Leal, MD, a professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine, as well as medical director of the Clinical Trials Office at Winship Cancer Institute, outlined key considerations for medical oncologists in recognizing and diagnosing Lambert-Eaton myasthenic syndrome (LEMS), particularly in the context of small cell lung cancer (SCLC) and, in rarer cases, non–small cell lung cancer (NSCLC).

She emphasized that timely identification of LEMS is critical, as early symptoms may be subtle and easily attributed to cancer-related deconditioning or treatment effects, leading to missed or delayed diagnosis. Leal underscored the need for oncologists to maintain a high index of suspicion when evaluating patients with neuromuscular symptoms. 

LEMS often presents with a clinical triad consisting of proximal muscle weakness, dysautonomia, and areflexia or hyporeflexia. Proximal weakness, particularly when out of proportion to the patient’s disease burden or functional status, should prompt consideration of LEMS. Leal stressed that some symptoms may be mistakenly attributed to systemic illness or chemotherapy-related fatigue, highlighting the importance of clinician awareness.

Once LEMS is suspected, a thorough neurologic examination is essential, followed by confirmatory diagnostic testing. Leal explained the importance of ordering voltage-gated calcium channel (VGCC) antibody testing, which is highly specific for LEMS and can confirm the diagnosis in the majority of cases. She noted that VGCC testing should be pursued promptly whenever clinical suspicion arises.

Videos

Ticiana Leal, MD, discusses clinical considerations surrounding the diagnosis of LEMS in patients with lung cancer. 

Managing LEMS in SCLC and Oncology Care | Supplements and Featured Publications

Accurate Symptom Identification and Guidelines Support LEMS Screening and Diagnosis: With Jacob Sands, MD; and Shailee Shah, MD

Dr Leal on Clinical Considerations Surrounding the Diagnosis of LEMS in Patients With Lung Cancer