Uveitis in Patients Treated with CTLA-4 and PD-1 Checkpoint Blockade Inhibition

Area of Science:

• Ophthalmology
• Oncology
• Immunology

Background:

• Immune checkpoint inhibitors (ICIs) like CTLA-4 and PD-1/PD-L1 blockers are revolutionizing cancer treatment.
• Ocular side effects from ICIs are increasingly recognized but not fully understood.
• Noninfectious uveitis is a potential adverse event associated with these therapies.

Purpose of the Study:

• To investigate the association between CTLA-4 and PD-1/PD-L1 checkpoint inhibitor therapy and the development of noninfectious uveitis.
• To characterize the clinical presentation and outcomes of uveitis in patients receiving these immunotherapies.

Main Methods:

• A survey was distributed to uveitis specialists globally.
• The survey aimed to identify and collect data on patients who developed uveitis while undergoing treatment with specific ICIs.
• Included PD-1 inhibitors (pembrolizumab, nivolumab), PD-L1 inhibitors (atezolizumab, avelumab, durvalumab), and CTLA-4 inhibitor (ipilimumab).

Main Results:

• Fifteen patients from seven institutions were identified with uveitis post-ICI initiation.
• Malignant melanoma was the most frequent cancer diagnosis (13/15).
• Uveitis types included anterior, panuveitis, and posterior; one patient developed optic neuritis. Diagnosis occurred within 6 months for most patients, with corticosteroids being effective, though two experienced vision loss.

Conclusions:

• Checkpoint inhibitor therapy is linked to noninfectious uveitis.
• Ocular symptom awareness and prompt specialist referral are vital for patients on ICIs.
• Integrating ophthalmology consultation into oncology protocols may improve patient outcomes.