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Tan CH, Sayegh Y, Fasih-Ahmad S, Tse DT, Karp CL, Dubovy SR. Periocular granulomatous inflammatory lesions mimicking conjunctival melanoma recurrence in the setting of systemic nivolumab treatment. Am J Ophthalmol Case Rep 2024; 36:102025. [PMID: 39175930 PMCID: PMC11338984 DOI: 10.1016/j.ajoc.2024.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/09/2024] [Indexed: 08/24/2024] Open
Abstract
Purpose Conjunctival melanoma is a rare neoplasm with high rates of recurrence and metastasis. Traditional management includes surgical excision and cryotherapy, followed by adjuvant therapy as needed. Immune checkpoint inhibitors, including nivolumab, are a targeted treatment option with improved survival rates. However, various immune-related adverse effects have been reported with these drugs. While systemic granulomatous inflammation is a documented systemic side effect, it has rarely been reported in the conjunctiva and ocular adnexa. Observation A patient with a history of recurrent metastatic conjunctival melanoma presented with both a left sub-conjunctival and upper eyelid lesion after the commencement of treatment with nivolumab. The lesions were excised with a clinical suspicion for metastasis and consisted of noncaseating granulomatous inflammation with no evidence of malignancy on histopathologic examination. Infectious and primary autoimmune etiologies were ruled out. Conclusion and importance This is a biopsy-proven case of periocular immune checkpoint inhibitor-associated granulomatous inflammation.
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Affiliation(s)
- Charissa H. Tan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yoseph Sayegh
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sohaib Fasih-Ahmad
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David T. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R. Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Meinke J, Adamson MS, Saßmannshausen M, Ach T, Holz FG, Mauschitz MM. [Bilateral choroidal detachment and hypotension under treatment with checkpoint inhibitors]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02114-5. [PMID: 39347981 DOI: 10.1007/s00347-024-02114-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/16/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024]
Affiliation(s)
- Jonathan Meinke
- Universitäts-Augenklinik Bonn, Universität Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - Maike S Adamson
- Klinik für Onkologie, Hämatologie, Rheumatologie und Immunonkologie, Universität Bonn, Bonn, Deutschland
| | - Marlene Saßmannshausen
- Universitäts-Augenklinik Bonn, Universität Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Thomas Ach
- Universitäts-Augenklinik Bonn, Universität Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Frank G Holz
- Universitäts-Augenklinik Bonn, Universität Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Matthias M Mauschitz
- Universitäts-Augenklinik Bonn, Universität Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Quiruz L, Yavari N, Kikani B, Gupta AS, Wai KM, Kossler AL, Ludwig C, Koo EB, Rahimy E, Mruthyunjaya P. Ophthalmic Immune-Related Adverse Events and Association with Survival: Results from a Real-World Database. Am J Ophthalmol 2024:S0002-9394(24)00416-1. [PMID: 39271090 DOI: 10.1016/j.ajo.2024.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/24/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE Assessing immune-related ocular toxicities from immune checkpoint inhibitors (ICIs) is crucial, though rare. This study, utilizing real-world data, examines the occurrence of ophthalmic immune-related adverse events (irAEs) after ICI treatment and their impact on overall survival. DESIGN A retrospective cohort study METHODS: Data were obtained from TriNetX, an aggregated electronic health records database. Patients who developed ophthalmic irAEs within 1 year after the first instance of ICI therapy were included. Participants with defined ocular toxicities 6 months before ICI treatment were excluded. Subjects were paired with controls using propensity scores derived from demographics and cancer type. A Cox proportional hazard model was used to determine hazard ratios. A Kaplan-Meier survival function was evaluated with the log-rank test based on the development of ophthalmic irAEs in a 12-month landmark analysis. RESULTS A cohort of 41,020 patients comprising 57.4% males with a mean age of 65.2±11.9 years was included. The five most prevalent ophthalmic irAEs in this cohort were dry eye syndrome (2%), conjunctivitis (0.87%), blepharitis (0.51%), anterior uveitis (0.39%), and keratitis (0.38%). Dry eye syndrome was the most common irAE among all ICI classes. Subjects taking CTLA-4 inhibitor plus PD-1 inhibitor and CTLA-4 inhibitors had higher rates of anterior uveitis (1.39% and 1.29%, respectively) than PD-1 inhibitors (0.27%) and PD-L1 inhibitors (0.14%) within 1 year after taking ICI. After a 12-month landmark analysis, there was a significant decreased chance of survival for the following categories: any ophthalmic irAE (HR, 1.37; 95% CI, 1.20-1.56; P < 0.0001), neuro-ophthalmic irAE (HR, 1.53; 95% CI, 1.09-2.14; P = 0.0124), and cornea and ocular surface irAE (HR, 1.34; 95% CI, 1.15-1.56; P < 0.0001). CONCLUSIONS Ophthalmic irAEs involving the anterior segment are more frequent than the posterior segment, regardless of ICI class. Ophthalmic irAEs may also portend decreased survival. This insight could help guide clinicians aggressively manage irAEs and allow patients to continue ICI therapy despite having ocular issues.
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Affiliation(s)
- Lee Quiruz
- Upstate Medical University College of Medicine, Syracuse, New York, USA
| | - Negin Yavari
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Bijal Kikani
- Upstate Medical University College of Medicine, Syracuse, New York, USA
| | - Ankur Sudhir Gupta
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Karen Michelle Wai
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea Lora Kossler
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Chase Ludwig
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Eubee Baughn Koo
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ehsan Rahimy
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Prithvi Mruthyunjaya
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA.
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Sunyur AM, Alkhayat D, Mohammad HA, Alahmadi HA, Alharbi LA, Khawaji ZY, Badawi AS. Clinical Patterns and Factors Contributing to Ophthalmic and Otologic Events Associated With Immune Checkpoint Inhibitors: A Narrative Review. Cureus 2024; 16:e66611. [PMID: 39258067 PMCID: PMC11386091 DOI: 10.7759/cureus.66611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 09/12/2024] Open
Abstract
Immune checkpoint inhibitors, which are a type of cancer immunotherapy, have been associated with the development of adverse events related to an overactive immune system caused by the effect of this type of therapy. It affects a wide range of organs, including the ear and eye. Ophthalmic toxicity related to immune checkpoint inhibitors usually occurs bilaterally. Corneal toxicity (mainly dry eye disease) and uveitis are the most commonly reported patterns of toxicity. Other patterns of involvement include optic neuritis, serous retinal detachment, keratitis, ophthalmoplegia, and ocular myasthenia, but are not limited to them. Potential factors contributing to the development of toxicity are age, previous history of ocular immune disease, type, doses, and duration of treatment, and race. Ototoxicity is also reported in the literature, usually manifesting as bilateral, symmetrical/asymmetrical hearing loss. Ear toxicity presenting as ear fullness, tinnitus, and vertigo has also been mentioned in the literature. Hearing loss is often associated with word/speech recognition. An audiogram usually shows a pattern of sensorineural hearing loss. Otitis media has also been reported to be a potential cause of ear toxicity. Immune checkpoint inhibitor toxicity was present more commonly when used along with other anti-neoplastic agents. Ear toxicity, which presumably results from damage to the melanocytes in the ear, often presents with other melanocytotic manifestations, like uveitis and vitiligo. According to the literature, some agents (ipilimumab, nivolumab, atezolizumab, and pembrolizumab) were more commonly associated with toxic effects on the eye and ear and more when combined with each other.
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Affiliation(s)
- Amal M Sunyur
- Medicine and Surgery, Taibah University, Medina, SAU
| | - Duaa Alkhayat
- Department of Clinical Oncology, Taibah University, Medina, SAU
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Brown AC, Quiroz J, Parikh DA, Li Y, Ritzer L, Rosen R, Deobhakta A. Cytokines in PD-1 immune checkpoint inhibitor adverse events and implications for the treatment of uveitis. BMC Ophthalmol 2024; 24:312. [PMID: 39075390 PMCID: PMC11285394 DOI: 10.1186/s12886-024-03575-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Immune checkpoint inhibitors (ICI) such as Programmed cell Death 1 (PD-1) inhibitors have improved cancer treatment by enhancing the immune system's ability to target malignant cells. Their use is associated with immune-related adverse events (irAEs), including uveitis. The profile of pro-inflammatory cytokines underlying Anti-PD-1-induced uveitis shares significant overlap with that of non-infectious uveitis. Current corticosteroid treatments for uveitis while effective are fraught with vision threatening side effects. The cytokine profile in ICI-related uveitis has a large overlap with that of noninfectious uveitis, this overlap strongly supports the potential for therapy that activates the PD-1 axis in the eye to treat uveitis. Indeed, ICI related uveitis often resolves with cessation of the ICI, restoring the endogenous PD-1 axis. The potential benefit of targeting many pro-inflammatory cytokines via local PD-1 axis activation is mitigating ocular inflammation while minimizing adverse effects.
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Affiliation(s)
- Aaron C Brown
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - José Quiroz
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Devayu A Parikh
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yafeng Li
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lukas Ritzer
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | - Avnish Deobhakta
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 E 14th Street, New York, NY, 10003, USA.
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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6
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Masalkhi M, Wahoud N, Moran B, Elhassadi E. Impact of immune checkpoint inhibitors on vision and eye health. Eye (Lond) 2024:10.1038/s41433-024-03212-z. [PMID: 38961146 DOI: 10.1038/s41433-024-03212-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/08/2024] [Accepted: 06/21/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Mouayad Masalkhi
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
| | - Noura Wahoud
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bridget Moran
- Mater Miscordiae University Hospital, Dublin, Ireland
| | - Ezzat Elhassadi
- Haematology Department, University Hospital Waterford, Waterford, Ireland
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7
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Kiraly P, Fischer MD. RETRACTED ARTICLE: Cystoid Macular Oedema in a Patient Treated with STING Agonist and Ezabenlimab for Disseminated Melanoma. Ophthalmol Ther 2024; 13:2061. [PMID: 38467992 PMCID: PMC11178736 DOI: 10.1007/s40123-024-00911-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Peter Kiraly
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom.
| | - M Dominik Fischer
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, United Kingdom
- Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany
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8
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Shu X, Shao Y, Chen Y, Zeng C, Huang X, Wei R. Immune checkpoints: new insights into the pathogenesis of thyroid eye disease. Front Immunol 2024; 15:1392956. [PMID: 38817600 PMCID: PMC11137266 DOI: 10.3389/fimmu.2024.1392956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Thyroid eye disease (TED) is a disfiguring autoimmune disease characterized by changes in the orbital tissues and is caused by abnormal thyroid function or thyroid-related antibodies. It is the ocular manifestation of Graves' disease. The expression of thyroid-stimulating hormone receptor (TSHR) and the insulin-like growth factor-1 receptor (IGF-1 R) on the cell membrane of orbital fibroblasts (OFs) is responsible for TED pathology. Excessive inflammation is caused when these receptors in the orbit are stimulated by autoantibodies. CD34+ fibrocytes, found in the peripheral blood and orbital tissues of patients with TED, express immune checkpoints (ICs) like MHC II, B7, and PD-L1, indicating their potential role in presenting antigens and regulating the immune response in TED pathogenesis. Immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment. However, it can also lead to the occurrence of TED in some instances, suggesting the abnormality of ICs in TED. This review will examine the overall pathogenic mechanism linked to the immune cells of TED and then discuss the latest research findings on the immunomodulatory role of ICs in the development and pathogenesis of TED. This will offer fresh perspectives on the study of pathogenesis and the identification of potential therapeutic targets.
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Affiliation(s)
| | | | | | | | | | - Ruili Wei
- Department of Ophthalmology, Changzheng Hospital of Naval Medicine University, Shanghai, China
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9
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Chen A, Chwalisz BK. Update on Neuro-ophthalmic Manifestations of Immune Checkpoint Inhibitors. Curr Neurol Neurosci Rep 2024; 24:113-122. [PMID: 38498093 DOI: 10.1007/s11910-024-01336-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitor (ICI) use has been on the rise for treatment of many different malignancies. Subsequently, more has been learned about immune-related adverse events (irAEs) that occur up to 12 months after treatment. This review summarizes the latest findings and management of neuro-ophthalmic associated irAEs. RECENT FINDINGS irAEs can affect the afferent and efferent neuro-ophthalmic pathways, thereby targeting central and peripheral nervous systems. As more cases are being reported, it is becoming apparent that neuro-ophthalmic irAEs often present with atypical features when compared to their spontaneous autoimmune counterparts. These neuro-ophthalmic presentations can also be signs of a more extensive inflammatory process that spans other organ systems, such as myopathies, endocrinopathies, and paraneoplastic syndromes. Awareness of neuro-ophthalmic irAEs and their atypical presentations can lead to early detection, termination of ICI treatment, and immunosuppressant therapy initiation.
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Affiliation(s)
- Amalie Chen
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Bart K Chwalisz
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
- Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital, Boston, MA, USA.
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Tomkins-Netzer O, Niederer R, Greenwood J, Fabian ID, Serlin Y, Friedman A, Lightman S. Mechanisms of blood-retinal barrier disruption related to intraocular inflammation and malignancy. Prog Retin Eye Res 2024; 99:101245. [PMID: 38242492 DOI: 10.1016/j.preteyeres.2024.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
Blood-retinal barrier (BRB) disruption is a common accompaniment of intermediate, posterior and panuveitis causing leakage into the retina and macular oedema resulting in vision loss. It is much less common in anterior uveitis or in patients with intraocular lymphoma who may have marked signs of intraocular inflammation. New drugs used for chemotherapy (cytarabine, immune checkpoint inhibitors, BRAF inhibitors, EGFR inhibitors, bispecific anti-EGFR inhibitors, MET receptor inhibitors and Bruton tyrosine kinase inhibitors) can also cause different types of uveitis and BRB disruption. As malignant disease itself can cause uveitis, particularly from breast, lung and gastrointestinal tract cancers, it can be clinically difficult to sort out the cause of BRB disruption. Immunosuppression due to malignant disease and/or chemotherapy can lead to infection which can also cause BRB disruption and intraocular infection. In this paper we address the pathophysiology of BRB disruption related to intraocular inflammation and malignancy, methods for estimating the extent and effect of the disruption and examine why some types of intraocular inflammation and malignancy cause BRB disruption and others do not. Understanding this may help sort and manage these patients, as well as devise future therapeutic approaches.
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Affiliation(s)
- Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Centre, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Rachael Niederer
- Department of Ophthalmology, Te Whatu Ora, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - John Greenwood
- Institute of Ophthalmology, University College London, London, UK
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Centre, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Yonatan Serlin
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience and the Brain Repair Centre, Dalhousie University, Faculty of Medicine, Halifax, NS, Canada; Departments of Physiology and Cell Biology, Brain and Cognitive Sciences, Zlotowski Centre for Neuroscience, Ben- Gurion University of the Negev, Beer-Sheva, Israel
| | - Sue Lightman
- Institute of Ophthalmology, University College London, London, UK
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Pedroso Lima J, Ferreira AM, Quaresma V, Lopes M, Lorigo J, Azinhais P, Nunes P, Figueiredo A. Immunotherapy-induced adverse events in metastatic renal cell carcinoma: A case of rapid response and complex challenges. Urol Case Rep 2024; 53:102670. [PMID: 38362363 PMCID: PMC10867413 DOI: 10.1016/j.eucr.2024.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
A 55-year-old woman with dyspnea was diagnosed with a 9.5cm left renal clear cell carcinoma and extensive metastatic disease. Initial treatment with Sunitinib was effective but discontinued due to severe dermatitis. Nivolumab therapy led to complete metastasis resolution and consequently nephrectomy was performed at 12 months. Postoperatively, she developed Vogt-Koyanagi-Harada-like disease, necessitating Nivolumab suspension and vision improvement with corticosteroids. After 24 disease-free months, a new contralateral renal lesion and pulmonary metastases were identified, prompting cabozantinib treatment. This resulted in clinical improvement and a partial response at the first follow-up.
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Affiliation(s)
- João Pedroso Lima
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Ana Marta Ferreira
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Vasco Quaresma
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Manuel Lopes
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - João Lorigo
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Paulo Azinhais
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Pedro Nunes
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Urology and Renal Transplantation Department, Hospital and University Centre of Coimbra, Praceta Professor Mota Pinto, 3004-561, Coimbra, Portugal
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Zhang H, Houadj L, Wu KY, Tran SD. Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review. Diagnostics (Basel) 2024; 14:336. [PMID: 38337852 PMCID: PMC10855398 DOI: 10.3390/diagnostics14030336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
This review aims to provide an understanding of the diagnostic and therapeutic challenges of uveitis associated with immune checkpoint inhibitors (ICI). In the wake of these molecules being increasingly employed as a treatment against different cancers, cases of uveitis post-ICI therapy have also been increasingly reported in the literature, warranting an extensive exploration of the clinical presentations, risk factors, and pathophysiological mechanisms of ICI-induced uveitis. This review further provides an understanding of the association between ICIs and uveitis, and assesses the efficacy of current diagnostic tools, underscoring the need for advanced techniques to enable early detection and accurate assessment. Further, it investigates the therapeutic strategies for ICI-related uveitis, weighing the benefits and limitations of existing treatment regimens, and discussing current challenges and emerging therapies in the context of their potential efficacy and side effects. Through an overview of the short-term and long-term outcomes, this article suggests recommendations and emphasizes the importance of multidisciplinary collaboration between ophthalmologists and oncologists. Finally, the review highlights promising avenues for future research and development in the field, potentially informing transformative approaches in the ocular assessment of patients under immunotherapy and the management of uveitis following ICI therapy.
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Affiliation(s)
- Huixin Zhang
- Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada;
| | - Lysa Houadj
- Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada;
| | - Kevin Y. Wu
- Department of Surgery, Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC J1G 2E8, Canada
| | - Simon D. Tran
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
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Cotton CC, Chandrabhatla AS, Higgins ML, Shildkrot Y. Bilateral Vitiligo-Like Depigmentation of Choroid and Retinal Pigment Epithelium Associated with Ipilimumab-Nivolumab Therapy for Metastatic Cutaneous Melanoma. Case Rep Oncol 2024; 17:122-127. [PMID: 38264011 PMCID: PMC10805407 DOI: 10.1159/000535745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Ipilimumab and nivolumab are checkpoint inhibitors that are known to cause a multitude of inflammatory ocular adverse events. Here we report a patient with poliosis and symptomatic depigmentation of the choroid and retinal pigment epithelium (RPE) associated with checkpoint inhibitor therapy for cutaneous melanoma. Case Presentation The patient presented with floaters in both eyes and concerns for intraocular metastases of metastatic cutaneous melanoma after 1 month of therapy with ipilimumab and nivolumab. External examination revealed poliosis of her eyebrows and eyelashes. Fundus photography demonstrated multiple 1-3 disc-diameter hypopigmented placoid flat areas in the RPE/choroid exposing underlying choroidal vessels in both eyes. At subsequent evaluation 7 months later (after an additional 6 months of checkpoint inhibitor therapy), the lesions appeared more blanched. Evaluation nearly 20 months after the initial presentation showed no significant changes from her prior visit despite cessation of checkpoint inhibitor therapy for 13 months. Conclusion Checkpoint inhibitor therapy for cutaneous melanoma metastases can cause depigmentation of the choroid and RPE that must be differentiated from progression of intraocular melanoma.
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Affiliation(s)
- Caroline C. Cotton
- School of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, USA
- Department of Ophthalmology. University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Anirudha S. Chandrabhatla
- School of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, USA
- Department of Ophthalmology. University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Mackenzie L. Higgins
- Department of Ophthalmology. University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Yevgeniy Shildkrot
- Department of Ophthalmology, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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