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Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade.
Michel M Sun1, Nicolas Seleme, John J Chen
1Department of Ophthalmology (MMS, NS, LKG), Jules Stein Eye Institute, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California; Department of Ophthalmology (JJC), Mayo Clinic, Rochester, Minnesota; Department of Neurology (JJC, AZ, ES), Mayo Clinic, Rochester, Minnesota; Department of Ophthalmology & Visual Sciences (RDW), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Ophthalmology (JDB), Park Nicollet Health Services, Minneapolis, Minnesota; Department of Ophthalmology (OS), University of Kentucky/Retina Associates of Kentucky, Lexington, Kentucky; Department of Neurology (LJM), SUNY Upstate Medical University, Syracuse, New York; Department of Ophthalmology (LJM), SUNY Upstate Medical University, Syracuse, New York; Department of Neurology (SG), University of Missouri-Kansas City, Kansas City, Missouri; Department of Ophthalmology (PMS), University of Vermont Medical Center, Burlington, Vermont; The Medical Eye Center (DAB), Manchester, New Hampshire; Department of Ophthalmology (JF), Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology (CLF), University of Sydney, Sydney, Australia ; Department of Neurology & Neurophysiology (CC-S), Liverpool Hospital, NSW, Australia ; Department of Neurology (SRH), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Neurology (BH), INI Eye Center, OSF Healthcare, University of Illinois College of Medicine, Peoria, Illinois; Department of Ophthalmology (MDS), University of Utah, Salt Lake City, Utah; Department of Ophthalmology (PSS), University of Colorado, Aurora, Colorado; and Department of Ophthalmology (ZW), University of Rochester Medical Center, Rochester, New York.
Immune checkpoint inhibitors like CTLA-4 and PD-1/PD-L1 can cause neuro-ophthalmic complications in cancer patients. Early recognition and treatment, often with corticosteroids, can improve outcomes for these serious side effects.
Area of Science:
- Neuro-oncology
- Ophthalmology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (CTLA-4, PD-1/PD-L1) are effective cancer treatments.
- Ophthalmologic complications are known but not fully understood.
- This study characterizes neuro-ophthalmic adverse events from these therapies.
Purpose of the Study:
- Investigate and characterize neuro-ophthalmic and ocular complications of immune checkpoint blockade.
- Understand clinical presentations and treatment outcomes.
- Increase awareness among specialists.
Main Methods:
- Survey distributed to neuro-ophthalmology specialists.
- Identified 31 patients receiving PD-1, PD-L1, or CTLA-4 inhibitors.
- Collected data on demographics, diagnoses, treatments, and outcomes.
Main Results:
- Common malignancies: melanoma and lung cancer.
- Median symptom onset: 14.5 weeks post-treatment initiation.
- Frequent complications included optic neuropathy, orbital inflammation, neuromuscular dysfunction, and cranial nerve palsy.
- Corticosteroids improved optic neuropathy outcomes.
Conclusions:
- Immune checkpoint inhibitors can cause diverse neuro-ophthalmic adverse events.
- Understanding these complications is crucial for patient care.
- Further research will guide specialist management.
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