Checkpoint Inhibitors

Checkpoint inhibitors are becoming more widely used in the management of cancer, so it is important for the ophthalmologist to examine the medication list carefully in a patient with new-onset uveitis.

Uveitis Associated with Immune Checkpoint Inhibitors

  • Immune checkpoint inhibitors are used increasingly to treat a variety of cancers, including metastatic melanoma and non-small cell lung cancer.
  • These drugs work by activating T-cells for attack against cancer cells.
  • They are associated with a variety of immune-related adverse events that most commonly affect the skin, GI tract, lungs, and endocrine glands. Ocular side effects are seen in ~1% of cases, with uveitis and dry eyes being the most common. Orbital inflammation can also occur.
  • In cases of uveitis, the most common presentation is bilateral anterior uveitis, but posterior uveitis, panuveitis, retinal vasculitis, and a Vogt-Koyanagi-Harada-like syndrome can also be seen.
  • Clear and timely communication with the oncologist is paramount.
  • Treatment of checkpoint inhibitor-induced uveitis is primarily with local steroids (topical, periocular, intravitreal depending on the site of inflammation). Systemic steroids could diminish checkpoint inhibitor activity.
    • In milder cases, checkpoint inhibitor treatment can be continued. 
    • In severe cases consult with oncologist, treatment may need to be discontinued.

Immune Checkpoint Inhibitors Associated with Uveitis

  • Ipilimumab
  • Pembrolizumab
  • Avelumab
  • Atezolizumab
  • Nivolumab
  • Cemiplimab
  • Durvalumab