Ocular Toxicity Profile of Targeted Cancer Therapy (TCT) at a US Tertiary Cancer Center

Abstract

Purpose: Targeted cancer therapy (TCT) is a significant advancement in oncology with promising survival improvement in patients with cancer and remarkable effects on various cancers. There is evidence suggesting a connection between specific TCT classes and the occurrence of immune-related adverse events (irAEs). Our study aims to investigate the potential ocular toxicities of different classes of TCT, provide a better understanding of these toxicities, and aid in the future development of screening and management recommendations for ocular irAEs. Design: Retrospective observational case series. Participants: Only ocular immune-related AEs were included in the study; patients on TCT who received a new ophthalmic diagnosis were seen at the MD Anderson Cancer Center. Methods: Between 2010 and 2019, we retrospectively reviewed the medical records of 6,354 patients on TCT at a large US tertiary cancer center. Results: The criteria for data analysis were met by 1861 patients. TCT was associated with a wide range of class-specific ocular irAEs. There was a statistically significant correlation between ocular toxicity with polytherapy with a p-value of <0.001. Furthermore, there was a statistically significant correlation between toxicity and BRAF, epidermal growth factor receptor (EGFR), and ICI <0.001, <0.001, and 0.006, respectively. Conclusion: Our cohort is the most extensive case series in English literature, demonstrating the increased risk of class-specific ocular toxicity associated with TCT, which sheds some light on the importance of developing standardized grading criteria and management guidelines.

Immune checkpoint monoclonal antibody-related adverse effects in neuro-ophthalmology

“…Monitoring and managing these side effects are an important aspect of using these therapies. [ 3 4 5 6 ]…”

“…The afferent NOirAEs included optic neuritis (12.8%), neuroretinitis (0.9%), and giant cell arteritis (GCA) (3.7%), whereas efferent NOirAEs comprised MG (45.0%), thyroid-like eye disease (12%), orbital myositis (13.8%), general myositis with ptosis (7%), internuclear ophthalmoplegia (0.9%), opsoclonus–myoclonus–ataxia syndrome (0.9%), and oculomotor nerve palsy (0.9%). [ 3 5 8 ]…”

“…The most common reported ocular irAEs (OirAEs) are blurred vision, conjunctivitis, ocular surface disease (such as dry eye, keratitis, and corneal perforation), uveitis, scleritis, retinal vascular occlusion, cystoid macular edema, retinal pigmented epithelium, and serous retinal detachment; whereas the most common neuro-ophthalmology irAEs (NOirAEs) are orbital inflammatory syndrome, thyroid orbitopathy, ocular myasthenia, and optic neuropathy. [ 1 2 3 ]…”