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