Erdafitinib-associated retinal alterations and rapid onset bilateral white cataracts
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Antoine G Sassine1, Yavuz Cakir1, Lyndsey Della Vecchia1
1The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Purpose:
This report aims to highlight the wide spectrum of ophthalmic adverse events associated with erdafitinib, a fibroblast growth factor inhibitor that blocks activation of the mitogen-activated protein kinase kinase (MAPK/MEK) cascade. The purpose of this report is to describe a case of erdafitinib-associated bilateral outer retinal alterations in the MEK-associated retinopathy spectrum and rapid onset bilateral total cataracts following a 20-month course of erdafitinib therapy.
Observations:
A 69 year old male with metastatic bladder cancer presented 47 days following treatment initiation with daily erdafitinib (8-mg) with mild new subretinal fluid and minimal associated subretinal debris in the left eye and accentuation/thickening of the interdigitation zone in the right eye. Over the course of treatment, improvements were noted, particularly with erdafitinib dose reduction. At 20 months, both eyes developed rapidly progressive mature cataracts with significant visual changes, necessitating bilateral cataract extraction.
Conclusions And Importance:
The potential stability of moderate outer retinal changes (i.e., ellipsoid zone/interdigitation zone, subretinal fluid) while continuing erdafitinib therapy is highlighted in this report. In addition, the importance of continued ophthalmic surveillance is emphasized given the possible association of anterior segment adverse events with long-term erdafitinib use.
Insights
Erdafitinib, a MEK inhibitor, can cause outer retinal changes and cataracts in cancer patients. Continued ophthalmic monitoring is crucial for early detection and management of these visual side effects.
Area of Science:
- Ophthalmology
- Oncology
- Pharmacology
Background:
- Erdafitinib is a fibroblast growth factor receptor inhibitor targeting the MAPK/MEK pathway.
- This report details ophthalmic adverse events in a patient undergoing erdafitinib therapy for metastatic bladder cancer.
Observation:
- A 69-year-old male developed outer retinal alterations, including subretinal fluid and interdigitation zone changes, during erdafitinib treatment.
- Rapidly progressive, mature bilateral cataracts emerged after 20 months of therapy, requiring surgical intervention.
Findings:
- Outer retinal changes showed potential stability with erdafitinib dose reduction.
- Long-term erdafitinib use was associated with the development of anterior segment complications, specifically cataracts.
Implications:
- Highlights the spectrum of ocular toxicity associated with erdafitinib, including MEK-associated retinopathy.
- Emphasizes the critical need for regular ophthalmic surveillance in patients receiving erdafitinib to monitor for both retinal and anterior segment adverse events.
