Clinical and Histological Characterization of Toxic Keratopathy From Depatuxizumab Mafodotin (ABT-414), an Antibody–Drug Conjugate

Abstract

ABT-414 accumulates in the basal corneal epithelium resulting in MEK due to increased apoptosis. Frequent lubrication and bandage contact lenses can provide symptom relief.

Corneal Epithelial Findings in Patients with Multiple Myeloma Treated with Antibody–Drug Conjugate Belantamab Mafodotin in the Pivotal, Randomized, DREAMM-2 Study

“…However, similar descriptions and images of these slit lamp microscopy and IVCM findings have been reported in studies and case reports with other ADCs (see ''Literature Review of Corneal Changes with ADCs'' section for additional details) [13,[15][16][17][18][19][20].…”

“…A review of these 28 studies and case reports revealed that ADCs directed against other targets have also demonstrated a high incidence of ocular surface AEs. The terminology used to describe these events varied among reports; however, several of these terms (e.g., ''microcyst-like corneal epitheliopathy,'' ''microcystic epitheliopathy,'' ''corneal epithelial microcyst'') suggest these events have a microcyst-like presentation in the corneal epithelium, consistent with the MECs described here with belamaf treatment [16,22,23]. Ocular surface AEs observed with ADCs have typically been described as multiple, bilateral, microcyst-like lesions in the superficial cornea [17][18][19].…”

“…Prior to this report, only a few publications have provided slit lamp microscopic images or IVCM images of MECs; each of these demonstrated similar observations to those reported here [15][16][17][18][19][20]. In a case report of a patient receiving trastuzumab emtansine (an ADC with a non-MMAF payload) for breast cancer, corneal changes were described as multiple, intraepithelial spherical lesions in the midperiphery on slit lamp microscopy [15].…”

“…Ocular surface AEs observed with ADCs have typically been described as multiple, bilateral, microcyst-like lesions in the superficial cornea [17][18][19]. In some reports, MECs were noted to start in the periphery and migrate centrally toward the pupil [16,17,19,24]. Overall, ocular surface changes observed and the methods for assessing these events in ADC clinical trials are often not well described [13].…”

“…In a case report of a patient receiving trastuzumab emtansine (an ADC with a non-MMAF payload) for breast cancer, corneal changes were described as multiple, intraepithelial spherical lesions in the midperiphery on slit lamp microscopy [15]. Hyperreflective lesions were observed on IVCM [15,16,18]. A second case report demonstrated similar findings but was later retracted as a result of patient unmasking [16,25].…”