Vogt-Koyanagi-Harada-like Syndrome Induced by Checkpoint Inhibitor Cemiplimab

Area of Science:

• Immunology
• Ophthalmology
• Dermatology

Background:

• Programmed cell-death protein 1 (PD-1) inhibitors are effective for cutaneous malignancies but can cause immune-related adverse events (irAEs).
• Ocular irAEs, such as uveitis, are infrequent but can be visually impactful, requiring careful management strategies.

Observation:

• A patient developed uveitis and mucous membrane ulcers after PD-1 inhibitor (cemiplimab) treatment for squamous cell carcinoma.
• Ophthalmic examination revealed Vogt-Koyanagi-Harada-like syndrome, necessitating treatment with topical, periocular, and systemic corticosteroids.
• Initial immunosuppressants (azathioprine, methotrexate) were discontinued due to side effects, leading to adalimumab (ADA) initiation.

Findings:

• Adalimumab (ADA) controlled intraocular inflammation but led to squamous cell carcinoma progression, requiring its discontinuation.
• Uveitis recurred upon ADA cessation. Restarting ADA, after risk-benefit discussion, achieved disease quiescence.
• Cutaneous neoplasms were managed with topical and intralesional therapies, with no new lesions noted on recent examination.

Implications:

• This case highlights the successful use of adalimumab (ADA) in managing sight-threatening ocular irAEs.
• It demonstrates a strategy to balance aggressive immunosuppression for ocular inflammation with the risk of promoting neoplastic disease progression.
• The findings suggest ADA can be a viable option for severe ocular irAEs in cancer patients, warranting careful monitoring and individualized treatment plans.