Bilateral optic disc edema as a possible complication of cabozantinib use–a case report

Abstract

Introduction Cabozantinib, which was approved by the Food and Drug Administration (FDA) in 2012, is a tyrosine kinase inhibitor widely used in the treatment of metastatic renal cell carcinoma (RCC) and medullary thyroid carcinoma. To date, no ocular adverse events have been reported by the FDA or on the package label. Here, we described a patient with metastatic RCC who developed bilateral optic disc edema after a 4-month course of cabozantinib. Case description A 55-year-old ethnic Chinese male with RCC with multiple metastases presented to our department with progressive blurred vision in both eyes for 1 month. He started taking cabozantinib 60 mg once daily 5 months prior to this presentation. Poor visual acuity and bilateral disc edema were then noted. Cabozantinib was discontinued after that, and 3-day pulse steroid therapy with methylprednisolone 1 g/day was given. The optic disc edema subsided gradually with limited improvement in visual acuity. Conclusion Bilateral optic edema should be considered as a complication associated with cabozantinib. We propose discontinuation of the treatment in cases such as that, and pulse steroid therapy should be considered if there is no contraindication.

Probable ponatinib-induced papilledema in a patient with acute lymphocytic leukemia

“…Although papilledema secondary to sunitinib, dasatinib, and imatinib (other tyrosine kinase inhibitors), and recently cabozantinib has been reported in the literature, 1 , 2 , 3 , 4 this is to our knowledge the first case of probable papilledema secondary to ponatinib treatment. Our patient presented with a minor inferonasal visual defect in his right eye without other ocular or neurologic symptoms suggestive of raised ICP.…”

“…Papilledema, disc edema due to raised intracranial pressure (ICP), is a very rare complication of leukemia therapy and particularly tyrosine kinase inhibitor (TKI) therapy. 1 , 2 , 3 , 4 This condition has variable presentations and can present asymptomatically. Targeted oncologic therapies are becoming increasingly popular, and more uncommon adverse events may not appear during the initial drug studies that comprise a drug monograph.…”

Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review

“…There have been reports associating systemic axitinib administration with microangiopathic retinal toxicity [ 93 , 94 ]. There is also a potential association between cabozantinib use and the development of bilateral optic disc edema [ 94 , 95 ]. Lenvatinib has been rarely linked to reversible posterior leukoencephalopathy syndrome (RPLS) [ 96 ].…”