Abstract
Purpose :
Immune checkpoint blockade using inhibitors of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) has shown clinically significant antitumor response and is now routinely used for the treatment of a number of cancers.
Herein we report a series of patients who developed intraocular metastases despite remission of the systemic disease following immunotherapy and discuss management options and prognostic implications.
Methods :
Retrospective case series from a single institution, national referral center for Oncology, over a twelve-month time. The prospectively-maintained Ocular Oncology database was queried under prospectively obtained institutional review board approval to identify patients who developed intraocular metastasis while on immune checkpoint inhibitor treatment.
Results :
Out of 32 patients diagnosed with intraocular metastases in 2018, 4 met the inclusion criteria. They were men, aged 38-72 years, affected by cutaneous melanoma (2), clear cell carcinoma, and NSCL. In all cases visual symptoms were unilateral, nonspecific (blurred vision, raised intraocular pressure, pain) and developed while the systemic disease was in remission. Metastases developed in the iris-ciliary body(2), choroid(1), vitreous(1). All but one patient presented with neovascular glaucoma, hence underwent intravitreal bevacizumab injections. One patient was successfully treated with proton beam radiotherapy to the whole anterior segment, one with cyberknife radiotherapy, one was enucleated because of massive choroidal invasion in a blind painful eye, one declined treatment. In all cases, brain MRI revealed CNS involvement within 4 months from the ocular involvement.
Conclusions :
Cancer immunotherapy has revolutionized the treatment of malignancies but the immune privilege of the eye may preclude ocular metastasis control. Ocular symptoms in these patients merit prompt referral to an Ocular Oncologist as conservative treatment of the eye is possible for limited disease. In our experience, however, ocular involvement was the premonitory sign of brain relapse and poor prognosis.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.