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A Case of Non-Resolving MEK Inhibitor-Associated Retinopathy
John R Chancellor1, David A Kilgore2, Ahmed B Sallam1
1Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Abstract:
The mitogen-activated kinase pathway plays an important role in cell survival, and its dysregulation is associated with cancers such as melanoma. Drugs designed to target this pathway have been associated with serous retinal detachments in a new entity termed MEK inhibitor-associated retinopathy (MEKAR). MEKAR has classically been described as self-limiting, with serous fluid often resolving without discontinuation of the drug. We present a case in which a patient undergoing treatment for metastatic melanoma with lacnotuzumab, a macrophage colony-stimulating factor inhibitor that blocks an upstream component of the mitogen-activated protein kinase pathway, developed serous retinopathy that did not resolve despite drug discontinuation.
Insights
A patient with metastatic melanoma developed persistent serous retinopathy despite discontinuing lacnotuzumab, a drug targeting the mitogen-activated protein kinase pathway. This challenges the typical self-limiting course of MEK inhibitor-associated retinopathy (MEKAR).
Area of Science:
- Oncology
- Ophthalmology
- Molecular Biology
Background:
- The mitogen-activated protein kinase (MAPK) pathway is crucial for cell survival and is frequently dysregulated in cancers like melanoma.
- MEK inhibitors targeting the MAPK pathway can cause serous retinal detachments, a condition known as MEK inhibitor-associated retinopathy (MEKAR).
- MEKAR is typically characterized by self-limiting serous fluid accumulation that resolves without drug cessation.
Observation:
- A patient with metastatic melanoma was treated with lacnotuzumab, a macrophage colony-stimulating factor inhibitor.
- Lacnotuzumab targets an upstream component of the MAPK pathway.
- The patient developed serous retinopathy during treatment.
Findings:
- The patient's serous retinopathy persisted even after discontinuation of lacnotuzumab.
- This case suggests that MAPK pathway inhibitors upstream of MEK may cause persistent retinopathy.
- The observed retinopathy did not follow the classically described self-limiting course of MEKAR.
Implications:
- This case expands the understanding of drug-induced retinopathy within the MAPK pathway inhibition spectrum.
- It highlights the need for vigilance in monitoring for persistent ocular side effects.
- Further research is warranted to elucidate the mechanisms and management of non-resolving retinopathy associated with upstream MAPK pathway inhibitors.
