Exploring the Role of Immune Checkpoint Inhibitors in Retinoblastoma Prognosis

Retinoblastoma is an intraocular cancer in children with genetic and immunologic complexities that play a significant role in determining their outcome and response to therapy. Although there have been great advancements made in both the diagnosis and management of this condition, the biological and immunologic diversity of the tumors continues to create obstacles in disease management. It is therefore important to have in-depth knowledge of the genetic and immune landscape of retinoblastoma to develop effective and sustainable management options. In this review, we will take a deep dive into the genetic changes associated with retinoblastoma and the tumor microenvironment, which is characterized by the eye's immune privilege. More emphasis will be put on the immune checkpoint molecules PD-1, PD-L1, CTLA-4, B7-H3, and emerging immune checkpoints, including LAG-3, TIM-3, and TIGIT, which help mediate immune escape mechanisms. Increased levels of these immune checkpoints have been shown to contribute to poor prognosis, aggressiveness of the disease, and chemotherapy resistance. Developments in monoclonal and bispecific antibodies, CAR-T therapy, and checkpoint inhibitors derived from phytoconstituents offer a potential solution for targeted therapy in retinoblastoma. This paper highlights the role of genetic and immunological indicators in improving the outcome of retinoblastoma.