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Drug-Induced Pseudo-Central Serous Chorioretinopathy in Carcinoma Patients
Sascha Mathias Jung1, Christophe Valmaggia1,2, Markus Jörger1
1Department of Ophthalmology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland.
Purpose:
Patients with carcinomas often share symptoms of vision deterioration as part of paraneoplastic retinopathy (PNR), based on a cross-reaction between antigens expressed by the underlying tumor and retinal proteins. However, some of the underlying symptoms may be explained by a drug-induced toxicity. The application of new therapeutic strategies with mitogen-activated protein kinase (MEK) and fibroblast growth factor receptor (FGFR) inhibitors in advanced cancers are still under evaluation for safety and tolerability, but also for dose-limiting toxicities. In the presented data, we identified a drug-induced pseudo-central serous chorioretinopathy (pCSC) to be the reason for central vision deterioration.
Methods:
A retrospective, observational, case-controlled study included seven patients receiving MEK and six patients receiving FGFR inhibitor treatment for bronchopulmonal cancer. We compared the clinical and diagnostic pictures of pCSC patients with that of 50 CSC patients (100 eyes) and 7 patients (14 eyes) with PNR. The activity of pCSC was assessed by clinical examination, supported by multimodal imaging. The relationships between clinical symptomatology and systemic disease activity were evaluated.
Results:
Three out of thirteen patients (23.1%) showed signs of pCSC (one FGFR and two MEK inhibitor patients). All three pCSC patients showed central bilateral detachment of the neurosensory retina on OCT imaging, but also paracentral multifocal lesions in the second subject. Compared to our CSC and PNR patients, the lesions in pCSC patients showed no lipofuscin irregularities on FAF. With reduction of the MEK treatment, the lesions on one MEK subject disappeared and BCVA restored to 0.8. In one MEK- and the FGFR subject, the lesions reduced in size without therapy discontinuation.
Conclusion:
Based on our data, MEK and FGFR inhibitor-associated pCSC is a mild, self-limited retinopathy that seems to disappear simultaneously or shortly after discontinuation of medication, with subsequent restoration of the central visual function.
Insights
New cancer drugs, MEK and FGFR inhibitors, can cause pseudo-central serous chorioretinopathy (pCSC), a mild vision issue. This drug-induced retinopathy often resolves after stopping the medication, restoring visual function.
Area of Science:
- Ophthalmology
- Oncology
- Pharmacology
Background:
- Patients with cancer may experience vision loss due to paraneoplastic retinopathy (PNR) or drug toxicity.
- Mitogen-activated protein kinase (MEK) and fibroblast growth factor receptor (FGFR) inhibitors are novel cancer therapies with potential dose-limiting toxicities.
- Central vision deterioration in cancer patients can be challenging to differentiate between PNR and drug-induced effects.
Purpose of the Study:
- To identify and characterize drug-induced pseudo-central serous chorioretinopathy (pCSC) in patients treated with MEK or FGFR inhibitors.
- To differentiate pCSC from PNR and compare its clinical and diagnostic features with central serous chorioretinopathy (CSC).
Main Methods:
- A retrospective, observational, case-controlled study involving 13 patients treated with MEK or FGFR inhibitors.
- Comparison of clinical and multimodal imaging findings of pCSC patients with 50 CSC patients and 7 PNR patients.
- Assessment of pCSC activity and correlation with systemic disease activity and treatment adjustments.
Main Results:
- Three of 13 patients (23.1%) developed pCSC, presenting with bilateral neurosensory retinal detachment on OCT.
- pCSC lesions showed no lipofuscin irregularities on fundus autofluorescence, distinguishing them from CSC and PNR.
- Lesions resolved or reduced in size with MEK treatment reduction or discontinuation, leading to visual function restoration.
Conclusions:
- MEK and FGFR inhibitor-associated pCSC is a mild, self-limited retinopathy.
- pCSC typically resolves shortly after medication discontinuation, with subsequent restoration of central visual function.
- Early identification and management of pCSC are crucial for preserving visual acuity in cancer patients undergoing targeted therapy.
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