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Kaczmarek JV, Bogan CM, Pierce JM, Tao YK, Chen SC, Liu Q, Liu X, Boyd KL, Calcutt MW, Bridges TM, Lindsley CW, Friedman DL, Richmond A, Daniels AB. Intravitreal HDAC Inhibitor Belinostat Effectively Eradicates Vitreous Seeds Without Retinal Toxicity In Vivo in a Rabbit Retinoblastoma Model. Invest Ophthalmol Vis Sci 2021; 62:8. [PMID: 34757417 PMCID: PMC8590161 DOI: 10.1167/iovs.62.14.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Current melphalan-based regimens for intravitreal chemotherapy for retinoblastoma vitreous seeds are effective but toxic to the retina. Thus, alternative agents are needed. Based on the known biology of histone deacetylases (HDACs) in the retinoblastoma pathway, we systematically studied whether the HDAC inhibitor belinostat is a viable, molecularly targeted alternative agent for intravitreal delivery that might provide comparable efficacy, without toxicity. Methods In vivo pharmacokinetic experiments in rabbits and in vitro cytotoxicity experiments were performed to determine the 90% inhibitory concentration (IC90). Functional toxicity by electroretinography and structural toxicity by optical coherence tomography (OCT), OCT angiography, and histopathology were evaluated in rabbits following three injections of belinostat 350 µg (2× IC90) or 700 µg (4× IC90), compared with melphalan 12.5 µg (rabbit equivalent of the human dose). The relative efficacy of intravitreal belinostat versus melphalan to treat WERI-Rb1 human cell xenografts in rabbit eyes was directly quantified. RNA sequencing was used to assess belinostat-induced changes in RB cell gene expression. Results The maximum nontoxic dose of belinostat was 350 µg, which caused no reductions in electroretinography parameters, retinal microvascular loss on OCT angiography, or retinal degeneration. Melphalan caused severe retinal structural and functional toxicity. Belinostat 350 µg (equivalent to 700 µg in the larger human eye) was equally effective at eradicating vitreous seeds in the rabbit xenograft model compared with melphalan (95.5% reduction for belinostat, P < 0.001; 89.4% reduction for melphalan, P < 0.001; belinostat vs. melphalan, P = 0.10). Even 700 µg belinostat (equivalent to 1400 µg in humans) caused only minimal toxicity. Widespread changes in gene expression resulted. Conclusions Molecularly targeted inhibition of HDACs with intravitreal belinostat was equally effective as standard-of-care melphalan but without retinal toxicity. Belinostat may therefore be an attractive agent to pursue clinically for intravitreal treatment of retinoblastoma.
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Affiliation(s)
- Jessica V Kaczmarek
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Carley M Bogan
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Janene M Pierce
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Yuankai K Tao
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States
| | - Sheau-Chiann Chen
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Qi Liu
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Xiao Liu
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kelli L Boyd
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - M Wade Calcutt
- Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, United States
| | - Thomas M Bridges
- Warren Center for Neuroscience Drug Discovery at Vanderbilt, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States
| | - Craig W Lindsley
- Warren Center for Neuroscience Drug Discovery at Vanderbilt, Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ann Richmond
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, Tennessee, United States.,Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States.,Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States
| | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States.,Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States.,Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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2
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Khodabande A, Ghassemi F, Asadi Amoli F, Riazi‐Esfahani H, Mahmoudzadeh R, Mehrpour M, Valipour N. Ocular safety of repeated intravitreal injections of Carboplatin and Digoxin: A preclinical study on the healthy rabbits. Pharmacol Res Perspect 2021; 9:e00814. [PMID: 34250764 PMCID: PMC8273607 DOI: 10.1002/prp2.814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
To evaluate the ocular safety of intravitreal carboplatin and digoxin injections as a new intravitreal chemotherapy option for retinoblastoma tumor vitreous seeds. Eighteen rabbits were divided randomly into three groups to receive intravitreal injection of Digoxin (6 rabbits), Carboplatin (7 rabbits), or Saline (5 rabbits). In every group, one eye randomly treated with 10 µg Digoxin in 0.1 cc or 1 µg Carboplatin or Saline, and the contralateral eye was considered as the control. All groups underwent three consecutive injections of the drugs with 1-week intervals. Baseline electroretinography (ERG) was recorded from both eyes of all the animals prior to injection and was repeated 1st day, 1st week, and 1st month after the last injection. All rabbits were sacrificed 1 month after the last injection, and histological studies were done. Mean a and b wave amplitudes decreased significantly at 1st day, 1st week, and 1st month after the last intravitreal injection of 10 µg Digoxin in comparison with other groups (p-value: .02). Contradictory, 1 µg Carboplatin injected eyes had minimal ERG changes. There were some nonspecific ERG changes with unclear clinical significance in non-injected contralateral control eyes of Digoxin and Carboplatin groups in comparison with the control eyes of the Saline group. Histological studies revealed considerable neural retinal atrophy in injected eyes of the Digoxin group. Intravitreal 10 µg Digoxin might have more local ocular toxicity in comparison with intravitreal Carboplatin in albino rabbit eyes. Future studies should assess the induced toxicity of intravitreal injection of these drugs on the non-injected contralateral eye.
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Affiliation(s)
- Alireza Khodabande
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Fariba Ghassemi
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Fahimeh Asadi Amoli
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Hamid Riazi‐Esfahani
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Raziyeh Mahmoudzadeh
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
- Wills Eye HospitalMid Atlantic RetinaThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Mohammad Mehrpour
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
| | - Niloufar Valipour
- Eye Research CenterFarabi Eye HospitalTehran University of Medical Science (TUMS)TehranIran
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3
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Bogan CM, Kaczmarek JV, Pierce JM, Chen SC, Boyd KL, Calcutt MW, Bridges TM, Lindsley CW, Nadelmann JB, Liao A, Hsieh T, Abramson DH, Francis JH, Friedman DL, Richmond A, Daniels AB. Evaluation of intravitreal topotecan dose levels, toxicity and efficacy for retinoblastoma vitreous seeds: a preclinical and clinical study. Br J Ophthalmol 2021; 106:288-296. [PMID: 33972235 PMCID: PMC8788260 DOI: 10.1136/bjophthalmol-2020-318529] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/22/2022]
Abstract
Background Current melphalan-based intravitreal regimens for retinoblastoma (RB) vitreous seeds cause retinal toxicity. We assessed the efficacy and toxicity of topotecan monotherapy compared with melphalan in our rabbit model and patient cohort. Methods Rabbit experiments: empiric pharmacokinetics were determined following topotecan injection. For topotecan (15 μg or 30 µg), melphalan (12.5 µg) or saline, toxicity was evaluated by serial electroretinography (ERG) and histopathology, and efficacy against vitreous seed xenografts was measured by tumour cell reduction and apoptosis induction. Patients: retrospective cohort study of 235 patients receiving 990 intravitreal injections of topotecan or melphalan. Results Intravitreal topotecan 30 µg (equals 60 µg in humans) achieved the IC90 across the rabbit vitreous. Three weekly topotecan injections (either 15 µg or 30 µg) caused no retinal toxicity in rabbits, whereas melphalan 12.5 µg (equals 25 µg in humans) reduced ERG amplitudes 42%–79%. Intravitreal topotecan 15 µg was equally effective to melphalan to treat WERI-Rb1 cell xenografts in rabbits (96% reduction for topotecan vs saline (p=0.004), 88% reduction for melphalan vs saline (p=0.004), topotecan vs melphalan, p=0.15). In our clinical study, patients received 881 monotherapy injections (48 topotecan, 833 melphalan). Patients receiving 20 µg or 30 µg topotecan demonstrated no significant ERG reductions; melphalan caused ERG reductions of 7.6 μV for every injection of 25 µg (p=0.03) or 30 µg (p<0.001). Most patients treated with intravitreal topotecan also received intravitreal melphalan at some point during their treatment course. Among those eyes treated exclusively with topotecan monotherapy, all eyes were salvaged. Conclusions Taken together, these experiments suggest that intravitreal topotecan monotherapy for the treatment of RB vitreous seeds is non-toxic and effective.
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Affiliation(s)
- Carley M Bogan
- Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica V Kaczmarek
- Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Janene M Pierce
- Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sheau-Chiann Chen
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelli L Boyd
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Thomas M Bridges
- Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee, USA
| | - Craig W Lindsley
- Center for Neuroscience Drug Discovery, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Albert Liao
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Terry Hsieh
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David H Abramson
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jasmine H Francis
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ann Richmond
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Pharmacology, Vanderbilt University, Nashville, Tennessee, USA.,VA Tennessee Valley Healthcare System Nashville Campus, Nashville, Tennessee, USA.,Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Anthony B Daniels
- Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA .,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.,Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Dehghani S, Ghassemi F, Mahmoudzadeh R, Khodabandeh A, Ghanaati H, Termehchi G. Five-year experience in treatment of retinoblastoma with intra-arterial chemotherapy: A single-center analysis. J Curr Ophthalmol 2021; 33:468-474. [PMID: 35128196 PMCID: PMC8772483 DOI: 10.4103/joco.joco_113_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose: To report our 5-year experience in treating retinoblastoma (RB) with intra-arterial chemotherapy (IAC) as a primary or secondary therapy, without adjuvant intravitreal chemotherapy. Methods: A retrospective study was conducted on 70 eyes with intraocular RB that were treated with primary or secondary IAC from December 2010-2015. Demographic characteristics, clinical features, tumor control, and treatment complications were compared and reported. Results: Thirty-seven eyes had received IAC as a secondary therapy after failed/incomplete response to systemic chemotherapy, and 33 eyes had received IAC as a primary treatment. The mean age of patients was 25 ± 8.9 months, and the patients were followed for a mean of 24.5 ± 16.26 months. Overall, enucleation rates were significantly higher in advanced tumors (Group D and E) in both groups (both P < 0.05). The main reason for enucleation in this study group was being unresponsive to treatment (27.4%), with 76% of latter patients having vitreous seeds at the time of enucleation. Enucleation rates did not differ significantly between patients receiving primary (18/33, 54%) or secondary IAC (18/37, 48%) (P = 0.06). In addition, recurrence and complication rates did not differ significantly between eyes receiving IAC as their primary or secondary treatment (P > 0.05). Conclusion: In primary and secondary treatment of RB with IAC, the main findings that are globe salvage, recurrence, and complication rates were comparable when no adjuvant intravitreal chemotherapy was used.
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5
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Demirci H, Wang Y, Li Q, Lin CM, Kotov NA, Grisolia ABD, Guo JL. Penetration of Carbon Nanotubes into the Retinoblastoma Tumor after Intravitreal Injection in LH BETA T AG Transgenic Mice Reti-noblastoma Model. J Ophthalmic Vis Res 2020; 15:446-452. [PMID: 33133434 PMCID: PMC7591833 DOI: 10.18502/jovr.v15i4.7778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 06/14/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the penetration of carbon nanotubes (CNTs) throughout retinoblastoma in a transgenic mice model. Methods CNTs functionalized with fluorescein isothiocyanate and targeting ligands biotin (CTN-FITC-Bio, 0.5mg/ml), or folic acid (CNT-FITC-FA, 0.5mg/ml) were injected into the vitreous of one eye of LH BETA T AG transgenic mice. Other eye did not receive any injection and was used as control. Three mice were sacrificed at days 1, 2, and 3. Eyes were enucleated and stained with 4,6-diamidino-2-phenylindole. The sections were imaged by fluorescent microscope. The images were transformed into grey-scale in MATLAB for intensity analysis. Background intensity was normalized by marking squares outside the eyeball and using the mean intensity of these squares. Fluorescent intensity (FI) for each image was measured by calculating the intensity of a same-sized square within retinoblastoma. Results Nine eyes of nine mice were included in each CNT-FITC-Bio and CNT-FITC-FA groups. The mean FI in CNT-FITC-Bio was 52.08 ± 6.33, 53.62 ± 9.00, and 65.54 ± 5.14 in days 1, 2, and 3, respectively. The mean FI in CNT-FITC-FA was 50.28 ± 7.37, 59.21 ± 6.43, and 58.38 ± 2.32 on days 1, 2, and 3, respectively. FI was significantly higher in eyes injected with CNT-FITC-Bio and CNT-FITC-FA compared to the control eyes (P = 0.02). There was no difference in FI between eyes with CNT-FITC-Bio and CNT-FITC-FA, and FI remained stable on days 1–3 in CNT-FITC-Bio, CNT-FITC-FA, and control eyes (P> 0.05). Conclusion We observed higher FI in eyes with CNT-FITC-Bio and CNT-FITC-FA compared to control eyes, showing penetration of CNTs throughout retinoblastoma. CNTs can be a carrier candidate for imaging or therapeutic purposes in retinoblastoma.
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Affiliation(s)
- Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Ann Arbor, MI, USA
| | - Yichun Wang
- Biointerfaces Institute, University of Michigan Ann Arbor, MI, USA.,Department of Chemical Engineering, University of Michigan Ann Arbor, MI, USA
| | - Qiaochu Li
- Electrical Engineering and Computer Science, University of Michigan Ann Arbor, MI, USA
| | - Cheng-Mao Lin
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Ann Arbor, MI, USA
| | - Nicholas A Kotov
- Biointerfaces Institute, University of Michigan Ann Arbor, MI, USA.,Department of Chemical Engineering, University of Michigan Ann Arbor, MI, USA.,Electrical Engineering and Computer Science, University of Michigan Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan Ann Arbor, MI, USA.,Department of Materials Science and Engineering, University of Michigan Ann Arbor, MI, USA.,Department of Macromolecular Science and Engineering, University of Michigan Ann Arbor, MI, USA.,Michigan Center for Integrative Research in Critical Care, University of Michigan Ann Arbor, MI, USA.,Michigan Institute of Translational Nanotechnology, University of Michigan Ann Arbor, MI, USA
| | - Anna Beatriz Diniz Grisolia
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Ann Arbor, MI, USA
| | - Jay L Guo
- Electrical Engineering and Computer Science, University of Michigan Ann Arbor, MI, USA
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Polski A, Xu L, Prabakar RK, Kim JW, Shah R, Jubran R, Kuhn P, Cobrinik D, Hicks J, Berry JL. Cell-Free DNA Tumor Fraction in the Aqueous Humor Is Associated With Therapeutic Response in Retinoblastoma Patients. Transl Vis Sci Technol 2020; 9:30. [PMID: 33062393 PMCID: PMC7533735 DOI: 10.1167/tvst.9.10.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aqueous humor (AH) liquid biopsy enables in vivo evaluation of tumor-derived cell-free DNA (cfDNA) from retinoblastoma (RB) eyes. Herein, we test our hypothesis that longitudinal dynamics of AH cfDNA—including tumor fraction (TFx) and somatic copy number alteration (SCNA) amplitude—correspond to therapeutic response. Methods Eyes with ≥3 AH extractions during intravitreal chemotherapy (IVM) or at secondary enucleation between 2015 to 2019 were included. AH cfDNA was sequenced to assess RB SCNA amplitude; ichorCNA software was used to estimate TFx. Eyes without SCNAs or with TFx < 0.10 across all samples were excluded. Therapeutic responses for each eye were determined from clinical records. Statistical analyses included Mann-Whitney U and Pearson correlation tests. Results Twenty eyes of 20 patients underwent ≥3 AH extractions; 6 eyes lacked SCNAs or had TFx < 0.10 throughout sampling and were excluded. Clinical progression was associated with significantly higher SCNA amplitudes and TFx values than regression (P ≤ 0.04). Relative increases in TFx (ΔTFx 1.86 ± 2.22) were associated with disease progression, whereas relative decreases in TFx (ΔTFx 0.53 ± 0.36) were associated with disease regression (P < 0.00001). A ≥15% increase in TFx relative to baseline during treatment was associated with an over 90-fold increased likelihood of clinical progression (odds ratio = 90.67, 95% confidence interval = 8.30–990.16, P = 0.0002). TFx and SCNA amplitude were significantly positively correlated throughout sampling (P ≤ 0.002). Conclusions Longitudinal changes in AH-derived cfDNA TFx and SCNA amplitude are concordant with clinical responses of intraocular RB during active therapy. Translational Relevance Longitudinal evaluation of AH cfDNA may provide an objective, quantitative way to monitor therapeutic response and disease burden in RB patients.
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Affiliation(s)
- Ashley Polski
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Liya Xu
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, CA, USA
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Rachana Shah
- Cancer and Blood Disease Institute at Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rima Jubran
- Cancer and Blood Disease Institute at Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, CA, USA.,USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
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7
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Nguyen M, Saunders J, Pacheco MC, Stacey AW. Progressive Preretinal Fibrosis with Late, Ossifying, Proliferative Retinopathy following Treatment for Retinoblastoma. Ocul Oncol Pathol 2020; 7:44-47. [PMID: 33796516 DOI: 10.1159/000509809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/29/2020] [Indexed: 02/03/2023] Open
Abstract
We report a case of retinal atrophy and progressive preretinal fibrosis in an eye previously treated with intravenous and intra-arterial chemotherapy (IAC), which evolved immediately after treatment with intravitreal injection of melphalan. The atrophy and fibrosis progressed later to proliferative retinopathy with dystrophic ossification. The patient was originally diagnosed with bilateral retinoblastoma at 4 months of age and was treated with systemic chemotherapy followed by IAC. New vitreous seeds developed and required treatment with intravitreal chemotherapy. There was resolution of vitreous seeding after 2 doses of intravitreal melphalan, but clinically the eye developed new, widespread retinal atrophy and fibrosis within 1 month of the second injection. This was followed by phthisis and late proliferative retinopathy nearly 1 year later. Retinoblastoma specialists should be aware of this potential complication of combined chemotherapy treatments.
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Affiliation(s)
- Minh Nguyen
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Jessica Saunders
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - M Cristina Pacheco
- Department of Pathology, University of Washington, Seattle, Washington, USA.,Department of Laboratories, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew W Stacey
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA.,Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington, USA
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INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR FOR THE MANAGEMENT OF NEOVASCULARIZATION IN RETINOBLASTOMA AFTER INTRAVENOUS AND/OR INTRAARTERIAL CHEMOTHERAPY: Long-Term Outcomes in a Series of 35 Eyes. Retina 2020; 39:2273-2282. [PMID: 30312257 DOI: 10.1097/iae.0000000000002339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the use of anti-vascular endothelial growth factor in the management of retinoblastoma. METHODS Retrospective review of 35 eyes (33 patients) treated with at least one intravitreal anti-vascular endothelial growth factor (ranibizumab and/or aflibercept) for new iris (n = 26) and/or retinal neovascularization (n = 21) after intravenous chemotherapy and/or intraarterial chemotherapy. RESULTS Most eyes (n = 31/35, 89%) were Group D or E. Previous treatments were salvage intraarterial chemotherapy after intravenous chemotherapy (n = 21/35, 60%), first-line intraarterial chemotherapy (n = 7/35, 20%), and first-line intravenous chemotherapy (n = 7/35, 20%). Associated clinical features were retinal ischemia (94%), retinal detachment (51%), active tumor (34%), intravitreal hemorrhage (43%), and/or glaucoma (17%). Mean 1.6 anti-vascular endothelial growth factor injections/eye were given; 28 eyes received ranibizumab, 2 aflibercept, and 5 both agents. Eight eyes underwent complementary treatments of ischemic retina. Resolution of neovascularization was observed in 28 eyes (n = 28/35, 80%). Globe salvage was achieved in 51% (n = 18/35), including 25% of those with active tumor (n = 3/12). One eye became phthisic. Sixteen eyes were enucleated, nine for tumor relapse/progression. Five eyes had high-risk histopathologic risk factors and received adjuvant intravenous chemotherapy. All patients are alive with no extraocular extension nor metastases (mean follow-up 3.7 years, range 1.1-7.6). CONCLUSION Intravitreal anti-vascular endothelial growth factor contributed to a globe salvage rate of 51% by providing conditions to continue conservative treatment.
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9
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Lemaître S, Poyer F, Fréneaux P, Leboucher S, Doz F, Cassoux N, Thomas CD. Low retinal toxicity of intravitreal carboplatin associated with good retinal tumour control in transgenic murine retinoblastoma. Clin Exp Ophthalmol 2020; 48:500-511. [PMID: 31872542 DOI: 10.1111/ceo.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Retinoblastoma is a rare intraocular malignancy in children. Current treatments have many adverse effects. New therapeutic approaches like intravitreal injections of chemotherapies are currently being developed but their toxicities need to be evaluated on animal models. This study compares the efficacy and toxicity of intravitreal melphalan, topotecan and carboplatin, alone or in combination (sequential administration), in the LHBetaTag retinoblastoma mice. METHODS Mice were divided into nine groups: control, carboplatin 1.5 and 4 μg, melphalan 0.1 and 1 μg, topotecan 0.1 and 1 μg, carboplatin 4 μg/topotecan 0.1 μg and melphalan 1 μg/topotecan 0.1 μg. The follow-up was performed using fundus imaging and optical coherence tomography combined with histopathological analysis. Absence of tumour and presence of calcified tumours were the criteria for therapeutic response assessment. Ocular complications were assessed after four weekly injections. Retinal toxicity was defined by the decrease of retinal thickness and of the number of retinal layers. RESULTS Topotecan was inactive on retinal tumours. Melphalan (1 μg) led to a complete tumour control in 91.7% of eyes. Carboplatin strongly decreased the tumour burden (85.7-93.8% of eyes without retinal tumour). The intravitreal injection itself led to ocular complications (25% of media opacities and 45.7% of retinal detachment). Only melphalan at 1 μg showed a strong retinal toxicity. The two combinations showed a good efficacy in reducing the number of eyes with retinal tumours with a reduced retinal toxicity. CONCLUSIONS This preclinical study suggests that intravitreal injection of carboplatin has a low toxicity and could be evaluated in clinical practice to treat patients suffering from retinoblastoma.
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Affiliation(s)
- Stéphanie Lemaître
- Institut Curie, Research Center, PSL Research University, Chemistry, Modeling and Imaging for Biology (CMIB), University Centre, Orsay, France.,INSERM U 1196, CNRS UMR 9187, Paris-Saclay University, Paris-Sud University, University Centre, Orsay, France.,Surgical Oncology Department, Ophthalmology Unit, Institut Curie, Hospital Group, Paris, France.,Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Florent Poyer
- Institut Curie, Research Center, PSL Research University, Chemistry, Modeling and Imaging for Biology (CMIB), University Centre, Orsay, France.,INSERM U 1196, CNRS UMR 9187, Paris-Saclay University, Paris-Sud University, University Centre, Orsay, France
| | - Paul Fréneaux
- Biopathology Department, Institut Curie, Hospital Group, Paris, France
| | - Sophie Leboucher
- Histology Platform, Institut Curie, Research Center, PSL Research University, Orsay, France
| | - François Doz
- Sorbonne Paris Cité, Paris Descartes University, Paris, France.,SIREDO Center (Care, Research and Innovation in Pediatric, Adolescent and Young Adults Oncology), Institut Curie, Hospital Group, Paris, France
| | - Nathalie Cassoux
- Surgical Oncology Department, Ophthalmology Unit, Institut Curie, Hospital Group, Paris, France.,Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Carole D Thomas
- Institut Curie, Research Center, PSL Research University, Chemistry, Modeling and Imaging for Biology (CMIB), University Centre, Orsay, France.,INSERM U 1196, CNRS UMR 9187, Paris-Saclay University, Paris-Sud University, University Centre, Orsay, France
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10
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Munier FL, Beck-Popovic M, Chantada GL, Cobrinik D, Kivelä TT, Lohmann D, Maeder P, Moll AC, Carcaboso AM, Moulin A, Schaiquevich P, Bergin C, Dyson PJ, Houghton S, Puccinelli F, Vial Y, Gaillard MC, Stathopoulos C. Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. "Alive, with good vision and no comorbidity". Prog Retin Eye Res 2019; 73:100764. [PMID: 31173880 DOI: 10.1016/j.preteyeres.2019.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 12/21/2022]
Abstract
Retinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a "state of metastatic grace" never to be violated. Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increase in eye preservation rate, definitive eradication of radiotherapy and reduction of systemic chemotherapy. Here we intend to review the relevant knowledge susceptible to improve the conservative management of retinoblastoma in compliance with the "state of metastatic grace", with particular attention to (i) reviewing how new imaging modalities impact the frontiers of conservative management, (ii) dissecting retinoblastoma genesis, growth patterns, and intraocular routes of tumor propagation, (iii) assessing major therapeutic changes and trends, (iv) proposing a classification of relapsing retinoblastoma, (v) examining treatable/preventable disease-related or treatment-induced complications, and (vi) appraising new therapeutic targets and concepts, as well as liquid biopsy potentiality.
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Affiliation(s)
- Francis L Munier
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland.
| | - Maja Beck-Popovic
- Unit of Pediatric Hematology-Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Guillermo L Chantada
- Hemato-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina; Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - David Cobrinik
- The Vision Center and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; USC Roski Eye Institute, Department of Biochemistry & Molecular Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tero T Kivelä
- Department of Ophthalmology, Ocular Oncology and Pediatric Ophthalmology Services, Helsinki University Hospital, Helsinki, Finland
| | - Dietmar Lohmann
- Eye Oncogenetics Research Group, Institute of Human Genetics, University Hospital Essen, Essen, Germany
| | - Philippe Maeder
- Unit of Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Annette C Moll
- UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Angel Montero Carcaboso
- Pediatric Hematology and Oncology, Hospital Sant Joan de Deu, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Alexandre Moulin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paula Schaiquevich
- Unit of Clinical Pharmacokinetics, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Ciara Bergin
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Paul J Dyson
- Institut des Sciences et Ingénierie Chimiques, Ecole Polytechnique Fédérale de Lausanne (EPFL), CH-1015, Lausanne, Switzerland
| | - Susan Houghton
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Francesco Puccinelli
- Interventional Neuroradiology Unit, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yvan Vial
- Materno-Fetal Medicine Unit, Woman-Mother-Child Department, University Hospital of Lausanne, Switzerland
| | - Marie-Claire Gaillard
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Christina Stathopoulos
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
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11
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Francis JH, Habib LA, Abramson DH. Vitreous Disease in Retinoblastoma: Clinical Findings and Treatment. ACTA ACUST UNITED AC 2017; 2:177-195. [PMID: 29034355 DOI: 10.1016/j.yaoo.2017.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jasmine H Francis
- Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, United States
| | - Larissa A Habib
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - David H Abramson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, United States
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12
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Mohney BG, Elner VM, Smith AB, Harbour JW, Smith BD, Musch DC, Smith SJ. Preclinical Acute Ocular Safety Study of Combined Intravitreal Carboplatin and Etoposide Phosphate for Retinoblastoma. Ophthalmic Surg Lasers Imaging Retina 2017; 48:151-159. [PMID: 28195618 DOI: 10.3928/23258160-20170130-09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the ocular toxicity of intravitreal carboplatin and etoposide phosphate (VP16P) in Dutch-Belted rabbits. MATERIALS AND METHODS Twenty-two adult male Dutch-Belted rabbits (Cohort 1) each received a single, bilateral intravitreal injection (0.05 mL). For Cohort 1, safety was assessed via electroretinograms (ERGs) and ocular examination. Of nine total groups in Cohort 1, the first five received the following single agents: Group 1: normal saline; Group 2: VP16P 75 µg; Group 3: VP16P 100 µg; Group 4: carboplatin 4 µg; and Group 5: carboplatin 8 µg. Groups 6 through 9 received the following combination of carboplatin/ VP16P, respectively: Group 6: 8 µg/75 µg, Group 7: 8 µg/50 µg, Group 8: 4 µg/50 µg, and Group 9: 2 µg/25 µg. Cohort 2 consisted of 15 Dutch-Belted rabbits in seven groups (Groups 10 through 16), each receiving a single, bilateral intravitreal injection. For Cohort 2, safety was assessed via histopathology. RESULTS Groups 2 through 8 demonstrated a statistically significant decrease (relative to Group 1) in at least one ERG waveform amplitude obtained 4 weeks postinjection (P < .05). Group 9 (carbo 2 µg/VP16P 25 µg) did not manifest ERG toxicity. Fundoscopic toxicity consisted of slight-to-moderate attenuation of vessels in rabbits receiving doses above carbo 4 µg/VP16P 50 µg. Histopathologic retinal toxicity (Cohort 2) was dose-dependent, ranging from full-thickness atrophy in rabbits receiving the highest dose to normal in rabbits receiving carbo 2 µg/VP16P 25 µg. CONCLUSIONS Combined carboplatin and VP16P may be compatible for intravitreal injection therapy, and a single dose of 2 µg/25 µg appears to be safe in a rabbit model. These agents may be a safer alternative to intravitreal melphalan (Alkeran; GlaxoSmithKline, Brentford, United Kingdom) for the treatment of vitreous seeds in retinoblastoma. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:151-159.].
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13
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Karl MD, Francis JH, Iyer S, Marr B, Abramson DH. Intraocular Pressure Changes Following Intravitreal Melphalan and Topotecan for the Treatment of Retinoblastoma With Vitreous Seeding. J Pediatr Ophthalmol Strabismus 2017; 54:185-190. [PMID: 28092395 PMCID: PMC5473509 DOI: 10.3928/01913913-20161116-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/05/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the impact of intravitreal chemotherapy on intraocular pressure (IOP) in children with retinoblastoma. METHODS This was a retrospective study of 10 eyes of 10 patients with retinoblastoma (7 males, 3 females, mean age: 33.6 ± 9.4 months) with vitreous seeding injected with intravitreal melphalan and topotecan. IOP was measured with Tonopen (Reichert, Inc., Buffalo, NY) at baseline prior to injecting and then repeatedly following each intravitreal injection. RESULTS Mean pre-injection IOP was 8.2 ± 2.3 mm Hg (range: 4 to 12 mm Hg). Mean IOP 1 to 30 seconds after intravitreal melphalan (first injection) was 45.4 ± 14.3 mm Hg. The IOP of 89.5% of patients declined to 29 mm Hg or less in a mean 153.3 ± 97.5 seconds. Mean IOP 1 to 30 seconds after intravitreal topotecan (second injection) was 44.5 ± 11.0 mm Hg, which decreased to 31.0 ± 5.0 mm Hg by 150 seconds after injection. No significant relationship was found between age and post-injection IOP elevation. IOP exceeded the calculated mean arterial perfusion pressure in four encounters. CONCLUSIONS Intravitreal chemotherapy caused a transient rise in IOP. Post-injection IOP elevations can reach levels that may exceed mean arterial pressure. [J Pediatr Ophthalmol Strabismus. 2017;54(3):185-190.].
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14
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Abstract
OBJECTIVE To evaluate the clinical and histopathologic characteristics of patients who develop proliferative vitreoretinopathy after retinoblastoma treatment. DESIGN Retrospective review of three cases of proliferative vitreoretinopathy (PVR) that developed after successful treatment of retinoblastoma from 2003 to 2015. SUBJECTS Three patients with treated retinoblastoma who developed severe PVR and required enucleation. METHODS Review of clinical charts, fundus drawings, Ret-Cam 3 images, and histopathology specimens. MAIN OUTCOME MEASURES Clinical and histopathologic characterization of PVR in treated retinoblastoma. RESULTS Three patients developed severe PVR after sequential thermal laser combined with systemic chemotherapy for retinoblastoma. At presentation patients were 6, 7, and 9 months of age, and all had bilateral retinoblastoma. Time to development of proliferative tissue was 9, 12, and 20 months after initial treatment. Proliferation was characterized by progressive growth of white vascularized tissue with associated traction on the retina and sometimes hemorrhage. All patients underwent enucleation. Histopathologic evaluation revealed treated retinoblastoma tumor with a Type 3 regression pattern, pre- and subretinal fibrovascular tissue consistent with PVR, and reactive changes in the retinal pigment epithelium. None of the patients developed recurrence of retinoblastoma or systemic metastasis. CONCLUSION PVR uncommonly develops after successful treatment of retinoblastoma and may result in traction or rhegmatogenous retinal detachment along with vitreous hemorrhage. Early stages of proliferation may be difficult to distinguish from recurrent tumor. Enucleation may be required due to poor vision and inability to adequately monitor for tumor recurrence.
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Abstract
Targeted therapy in retinoblastoma (RB) is widely accepted as the current management tool with an aim of increasing drug availability at the tumor location. Inevitably the effect is several times higher compared to systemic delivery of chemotherapeutic drugs and carries less systemic toxicity. Despite tremendous advancement in saving life, eye salvage in advanced RB especially with active vitreous seeds remains a challenge. The hypoxic environment of the vitreous and reduced vitreous concentration of the drugs delivered makes these tumor seeds resistant to chemotherapy. Direct delivery of chemotherapeutic drugs into the vitreous cavity aids to overcome these challenges and is progressively being accepted worldwide. However, intraocular procedure in RB was abandoned due to high risk of extraocular tumor dissemination. Recently, the forbidden therapeutic technique was re-explored and modified for safe use. Although eye salvage rate has tremendously improved after intravitreal chemotherapy (IVitC), retinal toxicity, and vision salvage are yet to be validated. In our preliminary report of intravitreal melphalan in 11 eyes, we reported 100% eye salvage and 0% recurrence with an extended 15 months mean follow-up. In this review, we analyzed published reports on IVitC in RB via PubMed, Medline, and conference proceedings citation index, electronic database search, without language restriction that included case series and reports of humans and experimental animal eyes with RB receiving IVitC.
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Affiliation(s)
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Aziz HA, Kim JW, Munier FL, Berry JL. Acute Hemorrhagic Retinopathy following Intravitreal Melphalan Injection for Retinoblastoma: A Report of Two Cases and Technical Modifications to Enhance the Prevention of Retinal Toxicity. Ocul Oncol Pathol 2016; 3:34-40. [PMID: 28275601 DOI: 10.1159/000448718] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/24/2016] [Indexed: 11/19/2022] Open
Abstract
AIMS To report the occurrence of acute hemorrhagic retinopathy following intravitreal melphalan injection for retinoblastoma. METHODS This is a retrospective case series of 2 patients with retinoblastoma treated with intravitreal melphalan for vitreous seeding who developed acute hemorrhagic retinopathy. RESULTS Patient 1 is a 6-month-old female with bilateral retinoblastoma (Group D right eye and Group B left eye) treated with 4 cycles of systemic chemotherapy and 2 intravitreal melphalan injections in each eye. Patient 2 is a 10-month-old male with unilateral Group D retinoblastoma treated with 6 cycles of systemic chemotherapy and 2 injections of intravitreal melphalan. At the 1-week follow-up after the second injection, both patients had an acute hemorrhagic retinopathy that resulted in chorioretinal toxicity with a sharp demarcation line between the normal and abnormal retina. At the last follow-up (22 and 12 months, respectively), there was total tumor control and resolution of vitreous seeding in both patients. CONCLUSIONS Although intravitreal melphalan injection is effective for vitreous seeding in eyes with retinoblastoma, acute hemorrhagic retinopathy and diffuse chorioretinal atrophy is a possible complication of this treatment modality. Given the clinical findings observed in these patients, the development of this retinal toxicity most likely results from a retrohyaloid overdose. Consequently we suggest preventive measures aimed at limiting the risk of retrohyaloid injection.
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Affiliation(s)
- Hassan A Aziz
- The Vision Center at Children's Hospital Los Angeles, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA
| | - Francis L Munier
- Department of Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA
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17
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Süsskind D, Hagemann U, Schrader M, Januschowski K, Schnichels S, Aisenbrey S. Toxic effects of melphalan, topotecan and carboplatin on retinal pigment epithelial cells. Acta Ophthalmol 2016; 94:471-8. [PMID: 26893290 DOI: 10.1111/aos.12990] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/13/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical evidence of retinal pigment epithelium (RPE) alterations after intra-arterial (IAC) and intravitreal chemotherapy (IViC) of retinoblastoma has been reported. We, therefore, investigated the cellular toxic effects of melphalan, topotecan and carboplatin on the RPE in a cell culture model. METHODS The effects of melphalan, carboplatin and topotecan on ARPE19 cell morphology were examined by phase contrast microscopy. Cell proliferation was quantified by BrdU incorporation, cell viability studied via MTS assays, and cell densities were estimated by Crystal Violet staining, and apoptosis induction studied via caspase 3/7-activity assays after a 24-hr incubation period. Staurosporine, media without fetal bovine serum, diluents of melphalan, carboplatin and topotecan were applied as positive and negative controls, respectively. RESULTS We observed a concentration-dependent increase in the number and size of gaps in the ARPE19 cell layer with each drug. There was a significant decrease in proliferative activity and cell viability of RPE cells as well as an increase in apoptosis after 24 hrs culture in media supplemented with melphalan and topotecan. Carboplatin had comparable effects on cell proliferation and cell viability; however, no significant apoptotic impacts were observed. The three cytostatic drugs had insignificant effects on cell density measurements. CONCLUSIONS Morphological monitoring and toxicity assays indicate a direct toxic effect of melphalan and the other two cytostatic drugs on ARPE19 cells. Thus, a direct toxic effect of melphalan in vivo after IAC or IViC on the RPE seems probable and may explain the clinical and angiographic RPE alterations observed in some retinoblastoma patients.
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Affiliation(s)
- Daniela Süsskind
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
| | - Ulrike Hagemann
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
| | - Merle Schrader
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
- University Hospital of Ophthalmology; Carl-von-Ossietzky University; Oldenburg Germany
| | - Kai Januschowski
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
| | - Sven Schnichels
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
| | - Sabine Aisenbrey
- Centre for Ophthalmology; Eberhard-Karls University Tübingen; Tübingen Germany
- University Hospital of Ophthalmology; Carl-von-Ossietzky University; Oldenburg Germany
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18
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Francis JH, Marr BP, Brodie SE, Abramson DH. Anterior Ocular Toxicity of Intravitreous Melphalan for Retinoblastoma. JAMA Ophthalmol 2016; 133:1459-63. [PMID: 26378741 DOI: 10.1001/jamaophthalmol.2015.3119] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intravitreous injections of melphalan hydrochloride are increasingly used in the treatment of vitreous seeding of retinoblastoma. Although this technique can save eyes otherwise destined for enucleation, ocular salvage may be accompanied by local toxic effects. Posterior segment toxic effects in this context are well established. This report describes the toxic effects on the anterior segment following intravitreous administration of melphalan. OBSERVATIONS Our clinic cohort included 76 patients who received intravitreous injections of melphalan at Memorial Sloan Kettering Cancer Center from September 12, 2012, through April 15, 2015; data analysis was performed from April 15 through May 15, 2015. We report a series of 5 patients from this cohort who developed anterior segment toxic effects. These abnormalities were found at the injection site or within the meridian of the injection and included a traumatic cataract following an injection at an outside hospital, iris depigmentation and thinning, iris recession with retinal necrosis and hypotony, a filtering conjunctival bleb, and focal scleromalacia with localized pigmentation. CONCLUSIONS AND RELEVANCE Intravitreous injection of melphalan may result in toxic effects on the anterior segment of the eye, in addition to retinal abnormalities, and appears to be more common in the meridian of the injection where the drug concentration is highest.
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Affiliation(s)
- Jasmine H Francis
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brian P Marr
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Scott E Brodie
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York3Department of Ophthalmology, Mount Sinai School of Medicine, New York, New York
| | - David H Abramson
- Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York
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19
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Francis JH, Mondesire-Crump I, Marr BP, Brodie SE, Abramson DH. Cytopathological Evaluation of Ocular Surface and Needle Washings Following Intravitreal Melphalan Injections for Retinoblastoma. J Pediatr Ophthalmol Strabismus 2016; 53:96-98. [PMID: 26848591 PMCID: PMC5457357 DOI: 10.3928/01913913-20160311-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE There is concern that injections into eyes with retinoblastoma are dangerous and allow tumor escapement. This study attempted to determine this risk by investigating the presence of malignant cells in ocular surface and needle washings of eyes with retinoblastoma receiving intravitreal injections. METHODS Two hundred ocular surface and 202 needle washings were obtained from 280 injections into eyes with retinoblastoma. Each specimen underwent cytopathlogical assessment for the presence of malignant cells. RESULTS Cytopathological results revealed no malignant cells in all 200 ocular surface and 202 needle washing specimens. In the ocular surface washings, squamous cells, red blood cells, and inflammatory cells were found in 15, 2, and 2 specimens, respectively. In the needle washings, 4 specimens contained squamous cells but no red blood cells or inflammatory cells were found in any specimen. CONCLUSION With this injection and evaluation technique, no malignant cells were recovered, highlighting the low risk of the procedure. [J Pediatr Opthalmol Strabismus. 20XX;XX(XX):XX-XX.].
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Affiliation(s)
- Jasmine H. Francis
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, United States
| | | | - Brian P. Marr
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, United States
| | - Scott E. Brodie
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Mount Sinai School of Medicine, New York, NY, United States
| | - David H. Abramson
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, United States
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20
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Yanık Ö, Gündüz K, Yavuz K, Taçyıldız N, Ünal E. Chemotherapy in Retinoblastoma: Current Approaches. Turk J Ophthalmol 2015; 45:259-267. [PMID: 27800245 PMCID: PMC5082265 DOI: 10.4274/tjo.06888] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/10/2015] [Indexed: 12/01/2022] Open
Abstract
Retinoblastoma (RB) is the most common childhood malignant intraocular tumor. Although enucleation and external beam radiotherapy have been historically used, today the most commonly used eye-sparing approach is chemotherapy. Chemotherapy can be used in both intraocular and extraocular RB cases. Chemotherapeutic agents may be applied in different ways, including systemic, subconjunctival, intra-arterial and intravitreal routes. The main purposes of application of systemic therapy are to reduce the tumor size for local treatment (chemoreduction), or to reduce the risk of metastasis after enucleation surgery (adjuvant therapy). Intra-arterial chemotherapy with the current name “super-selective intra-arterial infusion therapy” could be applied as primary therapy in tumors confined to the retina or as a secondary method in tumor recurrence. The most important advantage of intra-arterial therapy is the prevention of systemic chemotherapy complications. Intravitreal chemotherapy is administered in the presence of persistent or recurrent vitreous seeding. The term “extraocular RB” includes orbital invasion and metastatic disease. Current treatment for orbital invasion is neoadjuvant chemotherapy followed by surgical enucleation and adjuvant chemotherapy and radiotherapy after surgery. In metastatic disease, regional lymph node involvement, distant metastases, and/or central nervous system (CNS) involvement may occur. Among them, CNS involvement has the worst prognosis, remaining at almost 100% mortality. In metastatic disease, high-dose salvage chemotherapy and autologous hematopoietic stem cell rescue therapy are the possible treatment options; radiotherapy could also be added to the protocol according to the side of involvement.
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Affiliation(s)
- Özge Yanık
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kıvılcım Yavuz
- Ankara University Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Nurdan Taçyıldız
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Emel Ünal
- Ankara University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
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21
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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Ghassemi F, Khodabande A. Risk definition and management strategies in retinoblastoma: current perspectives. Clin Ophthalmol 2015; 9:985-94. [PMID: 26089630 PMCID: PMC4467752 DOI: 10.2147/opth.s59828] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This manuscript focuses on high-risk factors of metastatic disease in retinoblastoma and evaluation of the current treatments of retinoblastoma. Presence of histopathologic high-risk factors is associated with a higher risk of local recurrence and systemic metastasis. Currently, globe-sparing therapies, including systemic chemotherapy, intra-arterial chemoreduction, intravitreal chemotherapy, focal consolidation, and combination therapies, are being used and investigated actively. Major advances are being made in the diagnosis and management of retinoblastoma that will lead to improved morbidity and mortality rates in patients with retinoblastoma. By saving the globes, fronting with some high-risk factors for metastasis would be inevitable. International multi-institutional prospective studies could resolve current uncertainties regarding the main tumor treatment regimens for each patient and indications for chemoprophylaxis for high-risk-factor-bearing retinoblastoma cases.
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Affiliation(s)
- Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Tehran Province, Islamic Republic of Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Tehran Province, Islamic Republic of Iran
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Lawson BM, Saktanasate J, Say EAT, Shields CL. Intravitreal chemotherapy provides control for massive vitreous seeding from retinoblastoma. J Pediatr Ophthalmol Strabismus 2014; 51 Online:e92-4. [PMID: 25490242 DOI: 10.3928/01913913-20141203-05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/12/2014] [Indexed: 11/20/2022]
Abstract
Treatment of vitreous seeds in retinoblastoma is challenging because of relatively poor chemotherapeutic drug penetration by standard intravenous or intra-arterial routes. Intravitreal monotherapy with melphalan is effective but has a narrow therapeutic window. The authors describe a case of massive vitreous seeding successfully controlled after combination intravitreal chemotherapy using melphalan and topotecan with preserved anatomic outcome.
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Francis JH, Abramson DH. Update on Ophthalmic Oncology 2013: Retinoblastoma and Uveal Melanoma. Asia Pac J Ophthalmol (Phila) 2014; 3:241-56. [PMID: 26107765 DOI: 10.1097/apo.0000000000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to discuss the clinical and translational content of the literature as well as advancement in our knowledge pertaining to retinoblastoma and uveal melanoma that were published from January to December 2013. DESIGN This study is a literature review. METHODS The search terms retinoblastoma and uveal melanoma were used in a MEDLINE literature search. Abstracts were studied, and the most relevant articles were selected for inclusion and further in-depth review. RESULTS In retinoblastoma, fewer eyes are lost because of the expanded use of ophthalmic artery chemosurgery and intravitreal melphalan, and the past year marks a deepening in our understanding of these modalities. Knowledge on the genetic underpinnings of uveal melanoma has broadened to include genes associated with a favorable prognosis. This is accompanied by promising results in the treatment of metastatic uveal melanoma. CONCLUSIONS This past year, there were important advancements in our knowledge of retinoblastoma and uveal melanoma.
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Affiliation(s)
- Jasmine H Francis
- From the Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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