Ipilimumab-induced hypophysitis involving the optic tracts and tuber cinereum evaluated using 3D fluid-attenuated inversion recovery

Tanaka, Fumine; Kogue, Ryota; Maeda, Masayuki; Umino, Maki; Nakai, Yasuo; Takeshita, Atsuro; Sakuma, Hajime

doi:10.1016/j.radcr.2017.11.007

Cited by 7 publications

(3 citation statements)

References 12 publications

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“…Interestingly, there seemed to be a difference in onset between groups of diseases, with ocular complications occurring earlier in the case of orbit/muscle and cranial nerve involvement, whereas patients with optic nerve involvement patients tended to present later. These results are in agreement with previous case reports of neuro-ophthalmic complications (14)(15)(16)(17)(18)20), uveitis complications (9), and nonocular irAEs (27)(28)(29), all of which have highest risk within the first 6 months after ICI initiation. It must be noted, however, that some of the neuro-ophthalmic conditions could have been secondary to the cancer itself, through either direct or indirect effect, and not a result of the ICI therapy, which is a potential confounder of the results.…”

Section: Discussionsupporting

confidence: 93%

“…Ophthalmic immune-related adverse events (OirAEs) have also been reported and can be extremely debilitating. Classic autoimmune conditions such as uveitis were initially reported (5,(9)(10)(11); however, there have been increasing cases of other ocular associations including optic neuropathy (12,13), orbital inflammation (14,15), thyroid-like ophthalmopathy (16), myasthenia gravis-like ophthalmopathy (10), orbital apex syndrome (17), hypophysitis (18), giant cell arteritis (19), and acute visual loss secondary to optic neuritis (20). The range of ocular presentations of immunotherapy complications seems to be extremely varied.…”

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confidence: 99%

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Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade

Sun

Seleme

Chen

et al. 2020

Journal of Neuro-Ophthalmology

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Background: In recent years, CTLA-4 and PD-1/PD-L1 checkpoint inhibitors have proven to be effective and have become increasingly popular treatment options for metastatic melanoma and other cancers. These agents work by enhancing autologous antitumor immune responses. Immune-related ophthalmologic complications have been reported in association with checkpoint inhibitor use but remain incompletely characterized. This study seeks to investigate and further characterize the neuro-ophthalmic and ocular complications of immune checkpoint blockade treatment. Methods: A survey was distributed through the secure electronic data collection tool REDCap to neuroophthalmology specialists in the North American Neuro-Ophthalmology Society listserv. The study received human subjects approval through the University of California at Los Angeles Institutional Review Board. The survey identified patients sent for neuro-ophthalmic consultation while receiving one or more of a PD-1 inhibitor (pembrolizumab, nivolumab, or cemiplimab); PD-L1 inhibitor (atezolizumab, avelumab, or durvalumab); or the CTLA-4 inhibitor ipilimumab. Thirty-one patients from 14 institutions were identified. Patient demographics, neuro-ophthalmic diagnosis, diagnostic testing, severity, treatment, clinical response, checkpoint inhibitor drug used, and cancer diagnosis was obtained. Results: The checkpoint inhibitors used in these patients included pembrolizumab (12/31), nivolumab (6/31), combined ipilimumab with nivolumab (7/31, one of whom also received pembrolizumab during their course of treatment), durvalumab (3/31), ipilimumab (2/31), and cemiplimab (1/ 31). Malignant melanoma (16/31) or nonsmall cell lung carcinoma (6/31) were the most common malignancies. The median time between first drug administration and the time of ophthalmological symptom onset was 14.5 weeks. Eleven

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade

Sun

Seleme

Chen

et al. 2020

Journal of Neuro-Ophthalmology

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“…Nivolumab and ipilimumab are checkpoint inhibitors that work by augmenting T-cell activation and proliferation, which ultimately results in an antitumor response. 2 The recommendation for the use of nivolumab and ipilimumab in the setting of recurrent SCLC, and nivolumab FDA approval, was initially based on phase 1/2 trials in which patients achieved durable responses with either nivolumab alone or various doses of nivolumab in combination with ipilimumab. 3 The combination of nivolumab and ipilimumab was therefore included in the National Comprehensive Cancer Network (NCCN) guideline as an option for relapsed SCLC.…”

Section: Introductionmentioning

confidence: 99%

Panuveitis in patient on ipilimumab/nivolumab combination for small-cell lung cancer treated with an intravitreal dexamethasone implant

Hefler

Bailey

Rahi

et al. 2020

J Oncol Pharm Pract

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Background Immunotherapy with checkpoint inhibitors has demonstrated durable responses and remarkable antitumor effects in a variety of cancers. Although these agents are generally well-tolerated, patients can experience immune-related adverse events (irAEs) that require prompt recognition by healthcare providers. Immune-related ocular toxicities are rare, but serious adverse events have been reported with the use of checkpoint inhibitors. Case presentation: Here, we describe a rare case of panuveitis during Nivolumab and Ipilimumab combination treatment in a patient being treated for recurrent Small Cell Lung Cancer (SCLC). The patient was managed with an injection of Ozurdex (Allergan, Madison, NJ), a dexamethasone intravitreal implant. The patient had a resolution of inflammation and an improvement in her vision and was able to resume nivolumab monotherapy without recurrence of the panuveitis. Conclusion This case highlights the importance of early recognition of ocular irAEs by ocular oncologists and the successful approach to treatment of immunotherapy-induced panuveitis in order to avoid permanent cessation of therapy.

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Toxicities of Novel Antineoplastic Therapies

Rajha

Yeung

2021

Oncologic Emergency Medicine

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Ipilimumab-induced hypophysitis involving the optic tracts and tuber cinereum evaluated using 3D fluid-attenuated inversion recovery

Cited by 7 publications

References 12 publications

Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade

Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade

Panuveitis in patient on ipilimumab/nivolumab combination for small-cell lung cancer treated with an intravitreal dexamethasone implant

Toxicities of Novel Antineoplastic Therapies

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