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Published on: December 8, 2023
Neurotrophic Keratitis Associated With Telisotuzumab Vedotin: A Case Report
Kavya Katragadda1, Travis K Redd, Kaleb S Abbott
1Sue-Anschutz Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO.
Purpose:
To describe the first reported case of neurotrophic keratitis (NK) associated with telisotuzumab vedotin (Teliso-V), a c-MET-targeted antibody-drug conjugate (ADC) approved for metastatic non-small cell lung cancer (NSCLC).
Case Report:
A 56-year-old woman with metastatic NSCLC developed bilateral, painless blurred vision approximately 10 weeks after initiating Teliso-V therapy. Initial findings of punctate keratopathy progressed to bilateral persistent corneal epithelial defects despite treatment with topical corticosteroids, preservative-free artificial tears, bandage contact lenses, prophylactic antibiotics, and amniotic membrane transplantation. Corneal esthesiometry demonstrated markedly reduced corneal sensation bilaterally, consistent with NK. Concurrent Grade 1 peripheral neuropathy also developed. Teliso-V was discontinued because of ocular toxicity. Following initiation of topical cenegermin 0.002% six times daily, epithelial defects resolved within one week in the left eye and three weeks in the right eye, with recovery of best-corrected visual acuity to 20/20 in both eyes and partial improvement in corneal sensation. No recurrence was observed six weeks after completion of therapy.
Conclusions And Importance:
This report describes the first documented case of NK associated with Teliso-V therapy. The temporal association between Teliso-V exposure, bilateral corneal hypoesthesia, persistent epithelial defects, and concurrent peripheral neuropathy suggests a potential neurotoxic mechanism related to the drug's monomethyl auristatin E payload. Clinicians should maintain a high index of suspicion for NK in patients receiving ADCs who present with painless visual decline and corneal epithelial disease. Early diagnosis and prompt treatment with cenegermin may facilitate corneal healing and prevent vision-threatening complications.
Insights
Neurotrophic keratitis (NK) is a potential side effect of telisotuzumab vedotin (Teliso-V), an antibody-drug conjugate. Early diagnosis and treatment with cenegermin can help resolve corneal issues.
Area of Science:
- Ophthalmology
- Oncology
- Pharmacology
Background:
- Telisotuzumab vedotin (Teliso-V) is an antibody-drug conjugate (ADC) targeting c-MET, approved for metastatic non-small cell lung cancer (NSCLC).
- Ocular toxicity is a known concern with some ADCs, but specific associations require detailed reporting.
Purpose of the Study:
- To report the first case of neurotrophic keratitis (NK) potentially associated with telisotuzumab vedotin (Teliso-V) therapy.
- To highlight the clinical presentation, management, and outcome of this adverse event.
Main Methods:
- A case report of a 56-year-old woman with metastatic NSCLC treated with Teliso-V.
- Detailed description of ocular findings, including corneal epithelial defects and reduced corneal sensation.
- Documentation of concurrent peripheral neuropathy and response to treatment with cenegermin.
Main Results:
- The patient developed bilateral blurred vision, punctate keratopathy, and persistent corneal epithelial defects 10 weeks after starting Teliso-V.
- Corneal esthesiometry confirmed reduced sensation, indicative of NK, alongside Grade 1 peripheral neuropathy.
- Treatment with topical cenegermin led to resolution of epithelial defects and visual recovery within weeks.
Conclusions:
- This case suggests a potential neurotoxic mechanism of Teliso-V, possibly linked to its monomethyl auristatin E payload, causing NK.
- Clinicians should consider NK in patients on ADCs presenting with visual decline and corneal abnormalities.
- Prompt diagnosis and treatment with cenegermin are crucial for managing Teliso-V-associated NK and preventing vision loss.
