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Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer
1Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
Abstract:
Immune checkpoint inhibitors (ICIs) are novel immunotherapy-based drugs that have become increasingly popular in the treatment of lung cancer. Researchers have recognized ocular immune-related adverse events (irAEs) secondary to ICIs because of their vision-threatening characteristics. However, they are incompletely characterized and no studies have reported the ICI-related ocular irAEs in lung cancer. Therefore, we aimed to comprehensively illustrate the clinical characteristics, contributory factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer, based on previously reported 79 patients. Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most common ICI-related ocular irAEs in lung cancer. Ptosis was the most common (36.71%) and the highest mortality (23.33%) of ophthalmoplegia. Patients in Asia and patients who underwent combination therapy with programmed cell death-1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors demonstrated significantly higher frequency of ophthalmoplegia than other ocular irAEs. Most ICI-related ophthalmoplegia and uveitis in lung cancer were observed in the first 10 weeks following the initiation of ICIs. Furthermore, the onset time of dry eye and other ocular irAEs was much longer. In addition, 92.31% of the patients with ocular irAEs other than ophthalmoplegia could be remised. In conclusion, ocular irAEs secondary to ICIs in lung cancer are non-negligible, particularly ophthalmoplegia. Ethnicity and the type of ICIs play important roles in the distribution of ocular irAEs. ICI-related ophthalmoplegia in lung cancer presented with early onset and worse prognosis features, thus necessitating further attention.
Insights
Immune checkpoint inhibitors (ICIs) for lung cancer can cause serious eye problems, especially ophthalmoplegia. Early detection and management are crucial for better outcomes in these vision-threatening immune-related adverse events.
Area of Science:
- Oncology
- Ophthalmology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICIs) are increasingly used for lung cancer treatment.
- Ocular immune-related adverse events (irAEs) from ICIs are vision-threatening but poorly understood in lung cancer patients.
- No prior studies have comprehensively detailed ICI-related ocular irAEs specifically in lung cancer.
Purpose of the Study:
- To comprehensively illustrate clinical characteristics, contributing factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer.
- To analyze data from 79 previously reported patients to provide insights into these adverse events.
Main Methods:
- Retrospective analysis of 79 patients with lung cancer experiencing ocular irAEs.
- Characterization of clinical features, onset times, and outcomes.
- Identification of common irAEs, risk factors, and treatment responses.
Main Results:
- Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most frequent ocular irAEs.
- Ptosis was the most common presentation of ophthalmoplegia, with a high mortality rate (23.33%).
- Asian ethnicity and combination ICI therapy (PD-1/CTLA-4) were linked to higher ophthalmoplegia rates; ophthalmoplegia and uveitis typically occurred within 10 weeks of ICI initiation.
Conclusions:
- Ocular irAEs, particularly ophthalmoplegia, are significant complications of ICIs in lung cancer.
- Ethnicity and ICI type influence ocular irAE distribution.
- ICI-related ophthalmoplegia in lung cancer presents early and has a worse prognosis, requiring heightened clinical attention.
