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carolina mercado, Noy Ashkenazy, Carol Karp, Gaofeng Wang, Anat Galor; Immunosuppression as a possible risk factor for interferon non- response in ocular surface squamous neoplasia. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3352.
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The mechanism by which ocular surface squamous neoplasia (OSSN) responds to topical interferon-alpha-2b (IFNα2b) is not known. We herein report on 3 cases of immunosuppressed patients whose tumors did not respond to topical IFNα2b therapy. The purpose of this series is to shed light on potential mechanisms of IFNα2b in OSSN.
Retrospective case series of 3 patients with biopsy proven OSSN who presented to Bascom Palmer Eye Institute and the Miami Veterans Affair Medical Center. They received topical IFNα2b but did not respond to treatment. These patients were found to have various causes for immunosuppression, including lymphoma on rituximab therapy, leukemia, and multiple myeloma.
Three white, immunosuppressed males (mean age 70 years, range 66- 76) were diagnosed with OSSN. Topical IFNα2b 1 million units/ml was started four times a day and utilized for a mean of 5 months (range 2-7 months) without adequate response (Figure 1). All patients were then switched to 5-fluorouracil (5-FU). Successful eradication of OSSN was achieved in one case, and improvement of OSSN in another. The latter patient was switched to mitomycin C (MMC) with subsequent resolution of OSSN. Clinical efficacy of 5-FU in the third case remains in progress.
These cases suggest that an intact immune system may be an important link between IFNα2b therapy and tumor resolution. As such, topical IFNα2b may not be an optimal choice in patients with underlying immunosuppression. It may be more effective in this patient population to switch to a non-immune modulating therapy such as 5-FU or MMC.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1: Photographs of case 1 illustrating (a) a gelatinous limbal lesion with leukoplakia in the right eye extending from 7:30 to 10 o'clock with 1 mm extension into the cornea, and (b) an opacity involving the limbus and cornea at approximately 4 o’clock in the left eye (black arrows). (c) Anterior segment high resolution ocular coherence tomography (HR-OCT) with thick hyper-reflective epithelium (black asterisk) and a sharp border between normal and abnormal epithelium (white arrow); (d, e) Following 6 months of IFNα2b, persistent OSSN was noted in both eyes (black arrows).
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