Melanoma-Associated Retinopathy Treated with Ipilimumab Therapy

Abstract

Melanoma-associated retinopathy (MAR) is a rare autoimmune syndrome in patients with melanoma characterized by visual disorders. MAR is induced by the degeneration of bipolar cells of the retina and the presence of serum autoantibodies against retina proteins. Ipilimumab, an anti-cytotoxic T lymphocyte-associated antigen 4 antibody, improves survival in previously treated patients with metastatic melanoma, but is responsible for a spectrum of immune-related adverse events. Administration of ipilimumab to patients with autoimmune diseases (such as MAR or vitiligo) is actually not recommended. We report a patient presenting with MAR occurring during a melanoma relapse. Surgery and chemotherapy had no effect on visual acuity and melanoma increased. In the absence of alternative antitumoral treatment, we focused on the vital prognosis and treated the patient with ipilimumab. Two years after the treatment the patient is free from new metastasis but has presented with exacerbation of vitiligo and MAR. In the very rare case of melanoma with autoimmune disease without a therapy option, ipilimumab could be discussed, taking into account the fact that it can be effective on tumor burden but can also increase autoimmunity.

Acute Exudative Paraneoplastic Polymorphous Vitelliform Maculopathy During Vemurafenib and Pembrolizumab Treatment for Metastatic Melanoma

“…23 Vitelliform retinal lesions in association with depigmented skin lesions have been documented in MAR. 8 Interestingly, checkpoint inhibitors can cause or exacerbate autoimmune diseases including MAR and vitiligo. 8 Favorable response to systemic immunosuppression in rare cases of ipilimumab-associated retinopathy is consistent with that possibility.…”

Bilateral Choroidopathy and Serous Retinal Detachments During Ipilimumab Treatment for Cutaneous Melanoma

“…In 3 reports that we could identify, a granulomatous panuveitic Vogt-Koyanagi-Harada syndrome–like response developed 2 weeks after the first dose of ipilimumab, 4 bilateral multifocal choroidal neovascularization developed in a patient receiving ipilimumab for 1 year, 5 and a case of melanoma-associated retinopathy developed after the fourth cycle of ipilimumab. 6 These cases were presumed to receive ipilimumab doses of 3 mg/kg.…”

Ocular and orbital side-effects of checkpoint inhibitors: a review article

“…The main clinical symptom is a sudden loss of vision or visual photopsias; however, MAR can be subclinical and detected only with retinal imaging and electroretinogram (ERG). One case of MAR has been reported with ipilimumab therapy [34]. The patient presented with progressive nonpainful loss of vision prior to the treatment with ipilimumab.…”