Immune Checkpoint Inhibitor-associated Uveitis: Review of Treatments and Outcomes

Dow, Eliot; Yung, Madeline; Tsui, Edmund

doi:10.1080/09273948.2020.1781902

Cited by 46 publications

(82 citation statements)

References 17 publications

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“…The onset of uveitis is reported mainly to occur within 2 months of starting CPIs. 7 , 13 , 26 This was generally the case in our cohort, with a median time to onset of 5 weeks (range 1–7 weeks). The exception was a single patient who developed anterior uveitis 2 years after completing 2 years of nivolumab treatment.…”

Section: Discussionsupporting

confidence: 65%

“…It is noteworthy that he had other ocular IrAEs while on treatment that did not lead to CPI discontinuation, while his anterior uveitis was difficult to control. It is well recognised that some IrAEs (including ocular IrAEs) 13 can occur months and years after stopping CPIs, and this case is a reminder to consider the need for ongoing follow-up, even in patients apparently entering long-term remission after completing treatment.…”

Section: Discussionmentioning

confidence: 89%

“…This can be challenging, because the ocular symptoms experienced may not directly correlate with the severity of inflammation identified. 14 Even so, in most of the case series published to date, the overwhelming majority of patients experiencing ocular irAEs have had their CPIs discontinued, 12 , 13 and uncertainty exists whether this line of action may impact overall treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of ocular IrAEs associated with CPIs are limited to small, single-digit case series and individual case reports, which principally report patients experiencing varying degrees of uveitis. 8 , 10 – 13 …”

Section: Introductionmentioning

confidence: 99%

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Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

et al. 2021

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Ocular immune-related adverse events (IrAEs) associated with use of checkpoint inhibitors (CPIs) in cancer therapeutics are relatively rare, occurring in approximately 1% of treated patients. Recognition and early intervention are essential because the degree of tissue damage may be disproportionate to the symptoms, and lack of appropriate treatment risks permanent loss of vision. International guidelines on managing ocular IrAEs provide limited advice only. Importantly, local interventions can be effective and may avoid the need for systemic corticosteroids, thereby permitting the continuation of CPIs. We present a single institution case series of eight affected patients managed by our multidisciplinary team. Consistent with previously published series and case reports, we identified anterior uveitis as the most common ocular IrAE associated with CPIs requiring intervention. Based on our experience, as well as published guidance, we generated a simple algorithm to assist clinicians efficiently manage patients developing ocular symptoms during treatment with CPIs. In addition, we make recommendations for optimising treatment of uveitis and address implications for ongoing CPI therapy.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

et al. 2021

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“…For example, vitiligo is associated with increased response to ICB in melanoma and may represent a tissue-specific response against a skin antigen that was triggered by the primary immune response to the tumor ( Byrne and Turk, 2011 ). Similarly, uveitis, in which inflammation of the anterior or posterior compartment of the eye occurs after ICB treatment ( Cunningham et al, 2020 ; Dow et al, 2020 ), may reflect aberrant expression of ocular antigens by tumor cells.…”

Section: Introductionmentioning

confidence: 99%

Understanding adverse events of immunotherapy: A mechanistic perspective

Burke

Grebinoski

Sharpe

et al. 2020

Journal of Experimental Medicine

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The treatment of many cancers has been revolutionized by immune checkpoint blockade (ICB) as a standard-of-care therapeutic. Despite many successes, a large proportion of patients treated with ICB agents experience immune-related adverse events (irAEs) in the form of clinical autoimmunity, ranging from mild to life threatening, that can limit cancer treatment. A mechanistic understanding of these irAEs is required to better treat or prevent irAEs and to predict those patients who are susceptible to irAEs. We propose several mechanisms that may contribute to the generation of irAEs: (1) preexisting susceptibility to autoimmunity, (2) aberrant presentation of “self” by the tumor, and (3) loss of tolerance driven by the tumor or tissue microenvironment.

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