Bilateral choroidal effusions and angle closure in the setting of systemic capillary leak syndrome from HLA-directed vaccine and pembrolizumab therapy for squamous cell carcinoma

Marin, A. Itzam; Deitz, Galia A.; Mudie, Lucy I.; Reddy, Amit K.; Palestine, Alan G.

doi:10.1016/j.ajoc.2022.101777

Cited by 3 publications

(5 citation statements)

References 11 publications

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“…In one case of pembrolizumab-induced SCLS reported by Mayo clinics, the patient responded poorly to steroids, and was successfully healed with IVIG and axitinib [5], a tyrosine kinase inhibitor that targets the vascular endothelial growth factor receptor 2 (VEGFR2). In our case and cases recently reported by Percik et.al [9] and Marin et.al [10], pembrolizumab-induced SCLS was successfully managed with steroids. Scholars suggested that in early SCLS patients, steroids help to alleviate the inflammatory process and thereby curb the development of SCLS; while in severe SCLS patients, the junction gap in the endothelial already formed, and steroids cannot fix the junctions and therefore cannot mitigate the symptoms [2].…”

Section: Discussionsupporting

confidence: 79%

“…Based on our experience, the onset of SCLS could be a sign of poor prognosis in patients with advanced cancer. In our case and the case reported by Marin et al [10], although pembrolizumab-induced SCLS was successfully curbed with steroids, the patients soon developed infections and died afterward. Apparently, SCLS could lead to a pause in anti-cancer treatment, and the application of steroids increased the risk of infections and cancer progression.…”

Section: Discussionsupporting

confidence: 65%

“…SCLS is a rare adverse effect of ICIs [8,9]. To our knowledge, there have been only four reported cases of pembrolizumab-induced SCLS [5,6,9,10]. The diagnosis of SCLS is based on systemic leakage of fluid into interstitials and the exclusion of other causes including sepsis, organ failure, immunological disorders, etc.…”

Section: Discussionmentioning

confidence: 99%

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Case report: Clinical experience of treating pembrolizumab-induced systemic capillary leak syndrome (SCLS) in one patient with metastatic gastroesophageal junction squamous cell carcinoma

Ni,

Ding,

et al. 2023

Pathol. Oncol. Res.

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Systemic capillary leak syndrome (SCLS) is a rare and complex adverse effect of immune checkpoint inhibitors (ICIs). The diagnosis of drug-induced SCLS is based on diffuse infusions of exudative fluid into the interstitial areas and the exclusion of other causes. The best management of ICIs-induced SCLS is not settled, though proper supportive care and corticosteroids were commonly applied as the first-line treatment. In our patient with advanced gastroesophageal junction squamous cell carcinoma, although ICIs-induced SCLS was successfully controlled with corticosteroids, the patient soon experienced cancer progress and died of pulmonary infections. Based on our experience and the reported cases by other hospitals, different stages of SCLS might respond differently to the same treatment. Therefore, a grading of ICIs-induced SCLS might help to stratify the patient for different treatment strategies. Besides, corticosteroids-sensitive patients, though waived from deadly SCLS, might be at higher risk of cancer progress and subsequent infections due to the application of corticosteroids. Considering that the inflammatory factors should be closely involved in the development of ICIs-induced SCLS, targeted therapy against the driver inflammatory cytokine might offer treatment regimens that are more effective and safer.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 65%

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Case report: Clinical experience of treating pembrolizumab-induced systemic capillary leak syndrome (SCLS) in one patient with metastatic gastroesophageal junction squamous cell carcinoma

Ni,

Ding,

et al. 2023

Pathol. Oncol. Res.

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“…Dry eye [52,53]; Corneal ulcer [51,54]; -Posterior segment Choroidal neovascular membrane/choroidal effusion [42,55,56]; Hypotony/macular edema [55,[57][58][59][60][61]; Optic neuritis [62,63]; Retinal vasculitis [64,65]; Serous retinal detachment [55,66].…”

Section: Ocular and Orbital Side Effects Other Than Uveitismentioning

confidence: 99%

Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review

Zhang,

Houadj,

et al. 2024

Diagnostics

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This review aims to provide an understanding of the diagnostic and therapeutic challenges of uveitis associated with immune checkpoint inhibitors (ICI). In the wake of these molecules being increasingly employed as a treatment against different cancers, cases of uveitis post-ICI therapy have also been increasingly reported in the literature, warranting an extensive exploration of the clinical presentations, risk factors, and pathophysiological mechanisms of ICI-induced uveitis. This review further provides an understanding of the association between ICIs and uveitis, and assesses the efficacy of current diagnostic tools, underscoring the need for advanced techniques to enable early detection and accurate assessment. Further, it investigates the therapeutic strategies for ICI-related uveitis, weighing the benefits and limitations of existing treatment regimens, and discussing current challenges and emerging therapies in the context of their potential efficacy and side effects. Through an overview of the short-term and long-term outcomes, this article suggests recommendations and emphasizes the importance of multidisciplinary collaboration between ophthalmologists and oncologists. Finally, the review highlights promising avenues for future research and development in the field, potentially informing transformative approaches in the ocular assessment of patients under immunotherapy and the management of uveitis following ICI therapy.

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“…In all but three patients, glucocorticosteroids were the first-line treatment, and five patients were subsequently treated with IVIg (Table 1). A fatal outcome was reported in 29% (4/14) of patient due to generalized edema [12], worsening anasarca associated with bacteremia [23], multiple thromboses with mesenteric ischemia [12], and of unspecified cause in the last case [9]. The remaining patients showed complete or partial recovery with variable Note: Methodological quality score assessed using the tool proposed by Murad et al [13] (Table S1).…”

Section: Systematic Reviewmentioning

confidence: 99%

Immune checkpoint inhibitor–associated capillary leak syndrome: A systematic review and a worldwide pharmacovigilance study

Bouibede

Jonville‐Béra

et al. 2023

J Intern Med

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Background. Although a few case reports have shown that immune checkpoint inhibitors (ICIs) are potential inducers of capillary leak syndrome (CLS), an incidental finding cannot be ruled out. The aim of this study was to describe the clinical characteristics of ICI-induced CLS through a systematic review and to assess a potential safety signal.Methods. Medline/PubMed, Embase, and Reactions Weekly were screened, and a global disproportionality study was performed using the World Health Organization pharmacovigilance database through January 15, 2023. A signal of disproportionate reporting was defined as a Bayesian information component (IC) with a 95% credibility interval (CrI) lower boundary that exceeds 0. Results.A total of 47 cases of ICI-associated CLS were included, 14 from the systematic review (of 61 screened articles) and 33 from VigiBase (of 34,058,481 reports of adverse drug reactions). The median time to CLS onset from the start of ICI was 12 weeks (interquartile range 8-49, n = 24). A total of 57% (8/14) of patients experienced an immunerelated adverse event (irAE) before CLS. A fatal outcome was reported in 23% (7/31) of patients. A significant overreporting of CLS was found with ICIs compared with all other drugs (IC 2.4, 95% CrI from 1.8 to 2.8). Conclusion.This study showed a significant signal of disproportionality reporting for ICI-induced CLS, characterized by a long time to onset, and compared with the idiopathic form of the disease with a less abrupt onset and a less consistent hemoconcentration pattern.

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Bilateral choroidal effusions and angle closure in the setting of systemic capillary leak syndrome from HLA-directed vaccine and pembrolizumab therapy for squamous cell carcinoma

Cited by 3 publications

References 11 publications

Case report: Clinical experience of treating pembrolizumab-induced systemic capillary leak syndrome (SCLS) in one patient with metastatic gastroesophageal junction squamous cell carcinoma

Case report: Clinical experience of treating pembrolizumab-induced systemic capillary leak syndrome (SCLS) in one patient with metastatic gastroesophageal junction squamous cell carcinoma

Diagnosing and Managing Uveitis Associated with Immune Checkpoint Inhibitors: A Review

Immune checkpoint inhibitor–associated capillary leak syndrome: A systematic review and a worldwide pharmacovigilance study

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