Ocular Toxicities in Setting of Immune Checkpoint Inhibitors

Abstract

Purpose : Immune checkpoint inhibition is an emerging therapeutic approach for cancer treatment. The targets of antibody blockades, checkpoint molecules cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1) and its ligand PD-L1, are also involved in peripheral immune tolerance. Inhibition at these checkpoints can unleash inflammation and has been associated with ocular complications infrequently described in the literature.

Methods : Retrospective case series, including 9 patients seen at the National Eye Institute and Washington D.C. Veteran’s Hospital being treated with single or combination immune checkpoint inhibitor.

Results : There were 2 patients with Vogt Koyanagi Harada (VKH) -like syndrome with serous detachments and vitiligo, 3 patients with non-granulomatous anterior uveitis 1 complicated by abducens nerve palsy secondary to autoimmune neuritis, 3 patients with new onset or exacerbation of blepharoconjunctivis or dry eye syndrome, and 1 patient with non-arteritic anterior ischemic optic neuropathy possibly related to chemotherapeutic. Average timing of reaction after starting new checkpoint inhibitor was 49.8 days (range 3 days to 5 months). Most side effects were controlled with topical or oral therapy with only 2 patients requiring cessation of chemotherapeutic due to vision threatening complications despite treatment.

Conclusions : As the use of checkpoint inhibitor therapy grows, autoimmune ocular adverse events may become more apparent. The majority of patients appear to respond to local or topical therapy without the need to stop their cancer therapy. However it is important to raise awareness both among clinicians and patients to facilitate early treatment.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.