Choroidal and Choriocapillaris Morphology in Pan-FGFR Inhibitor-Associated Retinopathy: A Case Report
Giuseppe Fasolino1, Laura Moschetta1, Jacques De Grève1
1Universitair Ziekenhuis Brussel, Brussels Health Campus, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette, Belgium.
Abstract:
Emerging anticancer agents such as the pan-FGFR Inhibitor have achieved remarkable improvements in the survival of patients with metastatic malignancies. Nevertheless they are still associated with specific ophthalmic toxicities. Understanding their pathophysiology can lead us to better clinical practice of life-threatening and vision-threatening circumstances. To investigate choroidal alterations as a potential pathophysiological mechanism of a serous detachment in bilateral pan-FGFR Inhibitor-Associated Retinopathy (FGFRAR), the morphology of the choroid and choriocapillaris were assessed. The choroidal thickness (ChT) and choriocapillaris flow void were measured by macular optical coherence tomography (OCT) and angiography (OCT-A), respectively. Data were collected at the baseline, then at one-month and two-months follow-ups after starting erdafitinib, in a single case of pulmonary angiosarcoma. Choroidal and choriocapillaris morphology showed stable ChT and choriocapillaris flow void at FGFRAR onset and relapse. To the best of our knowledge, this is the first analyzed case reported with flow-void OCT-angiography. Considering these results, FGFRAR in this patient does not seem to match the pachychoroid spectrum disorder definition; rather, an intracellular mechanism based on intracellular transduction pathways may be at work.
Insights
Pan-fibroblast growth factor receptor (FGFR) inhibitors improve cancer survival but cause eye toxicity. This study examined choroidal changes in FGFR inhibitor-associated retinopathy (FGFRAR), finding stable choroidal thickness and flow, suggesting an intracellular mechanism.
Area of Science:
- Ophthalmology
- Oncology
- Pharmacology
Background:
- Emerging pan-fibroblast growth factor receptor (FGFR) inhibitors offer improved survival for metastatic cancers.
- Ophthalmic toxicities are a known side effect of these anticancer agents.
- Understanding the pathophysiology of these toxicities is crucial for managing vision-threatening complications.
Observation:
- This case study investigated choroidal alterations in a patient with pulmonary angiosarcoma treated with erdafitinib.
- Macular optical coherence tomography (OCT) and OCT-angiography (OCT-A) were used to assess choroidal thickness (ChT) and choriocapillaris flow void.
- Measurements were taken at baseline, and at one and two months after initiating erdafitinib.
Findings:
- Choroidal thickness and choriocapillaris flow void remained stable at the onset and relapse of pan-FGFR Inhibitor-Associated Retinopathy (FGFRAR).
- This is the first reported case analyzing FGFRAR using flow-void OCT-angiography.
- The findings suggest FGFRAR in this patient does not align with pachychoroid spectrum disorders.
Implications:
- The observed stability in choroidal morphology suggests FGFRAR may involve intracellular mechanisms rather than pachychoroid changes.
- Further research into intracellular transduction pathways is warranted to elucidate FGFRAR pathophysiology.
- This understanding can guide improved clinical management of ocular toxicities associated with FGFR inhibitors.
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