Neuro-ophthalmic Complications of Immune-Checkpoint Inhibitors

Mukharesh, Loulwah; Chwalisz, Bart K

doi:10.1080/08820538.2021.1890796

Cited by 6 publications

(11 citation statements)

References 69 publications

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“…MRI of the orbits can show optic nerve enhancement, typically sparing the retrobulbar and proximal segment. 29 , 30 CSF is usually abnormal: in an 18-case series, 78% had elevated protein (median 93.5, range 50–380 mg/dL), 56% had pleocytosis (median WBC count 22, range 14–1195 cells/mm3), and 39% had OBCs. 29 AQP4 antibodies may be positive, particularly in patients presenting with a longitudinally extensive transverse myelitis.…”

Section: Ici Neurotoxicitiesmentioning

confidence: 97%

“… 25 , 29 Optic neuritis is rare, but when present can be painless (in contrast the typical non-ICI-related presentation) and affects both eyes in 64% of patients. 30 Demyelinating disease can manifest with brain and/or spinal cord lesions, so clinical features overlap with encephalitis and myelitis, without consistent methods for differentiating them in published case series. As in encephalitis and myelitis, the work-up includes MRI of the brain and spine, LP, and autoantibody evaluation.…”

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

“… 25 , 32 Patients with meningitis should have preserved level of consciousness and cognitive function. 30 , 32 The presence of altered mental status in many reported cases may suggest parenchymal involvement (i.e., encephalitis rather than meningitis), which is a limitation in the literature. 25 Patients require lumbar puncture to rule out an infectious meningitis.…”

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

“…Vessel abnormalities include narrowing or beading on angiography, concentric vessel wall enhancement on vessel wall imaging, and/or granulomatous, lymphocytic, or necrotizing vasculitis on biopsy. 30 , 35 There is limited published data to determine expected findings in ICI-treated patients, but studies in non-ICI-related PACNS are informative. Most patients have abnormal CSF with mild elevations in WBC count and protein, as well as non-specific MRI abnormalities that include cortical and subcortical infarction, parenchymal and leptomeningeal enhancement, and T2/FLAIR hyperintensity.…”

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

“…Although debate exists about whether PRES is an irAE-N, clinicians should be aware of PRES as a potential occurrence in the context of ICI treatment. 30 …”

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

See 4 more Smart Citations

A review of neurotoxicities associated with immunotherapy and a framework for evaluation

Burton

Eskian

Guidon

et al. 2021

Neuro-Oncology Advances

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Immuno-oncology agents, including immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T (CAR-T) cell therapies, are increasing in use for a growing list of oncologic indications. While harnessing the immune system against cancer cells has a potent anti-tumor effect, it can also cause widespread autoimmune toxicities that limit therapeutic potential. Neurologic toxicities have unique presentations and can progress rapidly, necessitating prompt recognition. In this article, we review the spectrum of central and peripheral neurologic immune-related adverse events (irAEs) associated with ICI therapies, emphasizing a diagnostic framework that includes consideration of the therapy regimen, timing of symptom onset, presence of non-neurologic irAEs, pre-existing neurologic disease, and syndrome specific features. In addition, we review the immune effector cell-associated neurotoxicity syndrome (ICANS) associated with CAR-T cell therapy and address diagnostic challenges specific to patients with brain metastases. As immunotherapy use grows, so too will the number of patients affected by neurotoxicity. There is an urgent need to understand pathogenic mechanisms, predictors, and optimal treatments of these toxicities, so that we can manage them without sacrificing anti-tumor efficacy.

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Section: Ici Neurotoxicitiesmentioning

confidence: 97%

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

“…Although debate exists about whether PRES is an irAE-N, clinicians should be aware of PRES as a potential occurrence in the context of ICI treatment. 30 …”

Section: Ici Neurotoxicitiesmentioning

confidence: 99%

See 3 more Smart Citations

A review of neurotoxicities associated with immunotherapy and a framework for evaluation

Burton

Eskian

Guidon

et al. 2021

Neuro-Oncology Advances

View full text Add to dashboard Cite

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A Review of Neurotoxicities Associated with Immune Checkpoint Inhibitors

Sahu

Sayegh²,

Li³

2022

Handbook of Cancer and Immunology

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Eosinophilic Vasculitis and Arteritic Anterior Ischemic Optic Neuropathy Associated With Anti-PD-L1 Therapy

Berry

Mullany

Quinlivan

et al. 2021

Journal of Immunotherapy

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Immune checkpoint inhibitor therapy is frequently associated with immune-related adverse events, which occasionally manifest with visual symptoms. Here, we describe a case of unilateral and sudden-onset painless vision loss in an 82-year-old man with metastatic non–small cell lung cancer receiving immunotherapy with the anti–programmed death-ligand 1 agent atezolizumab. Examination demonstrated a right-sided relative afferent pupillary defect, diffusely swollen optic disc, and delayed choroidal and retinal arterial filling on fundus fluorescein angiography, consistent with an arteritic anterior ischemic optic neuropathy. Histology of an ipsilateral temporal artery biopsy revealed a transmural eosinophilic infiltrate without granulomas, while serology revealed the presence of antineutrophil cytoplasmic antibodies. Peripheral eosinophilia was also noted, which preceded treatment by several months. This report highlights the importance of clinician awareness of immune checkpoint inhibitors and their systemic and ophthalmic complications, which rarely appear to extend to eosinophilic temporal arteritis.

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Neuro-ophthalmic Complications of Immune-Checkpoint Inhibitors

Cited by 6 publications

References 69 publications

A review of neurotoxicities associated with immunotherapy and a framework for evaluation

A review of neurotoxicities associated with immunotherapy and a framework for evaluation

A Review of Neurotoxicities Associated with Immune Checkpoint Inhibitors

Eosinophilic Vasculitis and Arteritic Anterior Ischemic Optic Neuropathy Associated With Anti-PD-L1 Therapy

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