Abstract
Purpose
To describe uveitis in patients treated with checkpoint inhibitors immune therapy for metastasized malignant melanoma.
Methods
Observational retrospective case series describing 6 patients with uveitis as an immune mediated toxicity during checkpoint inhibitor immune therapy in a single tertiary referral center in the Netherlands.
Results
In 2015–2018, six patients with uveitis as an immune‐related toxicity due to checkpoint inhibitor immune therapy for metastasized malignant melanoma have been identified. The age of patients varied between 45 and 71 years. Three of them received pembrolizumab and the other 3 patients received a combination of ipilimumab with nivolumab. The time to onset of uveitis after the initiation of the immune therapy varied between 2 days and 5 months with the most common onset between 2 and 3 months in 4/6 patients. In all patients, acute bilateral anterior uveitis was diagnosed with papillitis (3/6), subretinal fluid with subfoveal deposits (2/6) and cystoid macular edema (CME) (1/6). In 4/6 patients, uveitis was controlled with topical steroids. Two patients received additionally periocular steroid injections. In 5/6 patients a good control of inflammation was achieved with an excellent visual outcome. In one patient with persistent uveitis and CME despite topical and periocular treatment, anterior chamber tap cytology showed a predominantly T‐cel composition (86%).
Conclusions
Uveitis is a rare immune related toxicity of checkpoint inhibitor immune therapy which presents as an acute bilateral uveitis with good response to topical treatment and good visual prognosis. In refractory cases, complex therapeutic dilemma's can arise in these vulnerable patients.
To describe uveitis in patients treated with checkpoint inhibitors immune therapy for metastasized malignant melanoma.
Methods
Observational retrospective case series describing 6 patients with uveitis as an immune mediated toxicity during checkpoint inhibitor immune therapy in a single tertiary referral center in the Netherlands.
Results
In 2015–2018, six patients with uveitis as an immune‐related toxicity due to checkpoint inhibitor immune therapy for metastasized malignant melanoma have been identified. The age of patients varied between 45 and 71 years. Three of them received pembrolizumab and the other 3 patients received a combination of ipilimumab with nivolumab. The time to onset of uveitis after the initiation of the immune therapy varied between 2 days and 5 months with the most common onset between 2 and 3 months in 4/6 patients. In all patients, acute bilateral anterior uveitis was diagnosed with papillitis (3/6), subretinal fluid with subfoveal deposits (2/6) and cystoid macular edema (CME) (1/6). In 4/6 patients, uveitis was controlled with topical steroids. Two patients received additionally periocular steroid injections. In 5/6 patients a good control of inflammation was achieved with an excellent visual outcome. In one patient with persistent uveitis and CME despite topical and periocular treatment, anterior chamber tap cytology showed a predominantly T‐cel composition (86%).
Conclusions
Uveitis is a rare immune related toxicity of checkpoint inhibitor immune therapy which presents as an acute bilateral uveitis with good response to topical treatment and good visual prognosis. In refractory cases, complex therapeutic dilemma's can arise in these vulnerable patients.
| Original language | English |
|---|---|
| Pages (from-to) | 16-16 |
| Journal | Acta Ophthalmologica |
| Volume | 97 |
| Issue number | S262 |
| Publication status | Published - Mar 2019 |