Severe loss of vision during adjuvant interferon alfa-2b treatment for malignant melanoma

Lohmann, Chris P.; Kroher, G.; Bogenrieder, Thomas; Spiegel, D.; Preuner, J.

doi:10.1016/s0140-6736(99)00403-1

Cited by 50 publications

(23 citation statements)

References 3 publications

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“…Although, in most patients, visual acuity returns to normal when IFN is discontinued, visual loss can be permanent. [59][60][61] Of concern, in 1 series of 7 patients who developed retinopathy while undergoing treatment with IFN, 6 patients had received concurrent paroxetine. 61 In another series of 20 patients who received paroxetine for depression prophylaxis, 3 patients experienced retinal hemorrhage.…”

Section: Ocular Toxicitymentioning

confidence: 99%

Practical guidelines for the management of interferon‐α‐2b side effects in patients receiving adjuvant treatment for melanoma

Hauschild

Gogas

Tarhini

et al. 2008

Cancer

123

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Interferon-alpha-2b (IFNalpha2b) is the only effective adjuvant therapy for melanoma patients at high risk of recurrence that has been approved by regulatory authorities worldwide. However, IFN toxicities increase the risk of poor treatment compliance and impair the potential for benefit from this agent. A review of the literature demonstrated little recent attention to supportive care in the management of IFN toxicities. An international group of experts with extensive personal experience in the use of IFNs worked together to develop practical guidelines for the use of IFNs. Practical recommendations were developed for patient education on the use of IFN; initial patient assessment and monitoring, including contraindications to the use of IFN, monitoring and managing adverse events, and IFN dose modification and discontinuation; IFN injection procedures; treatment of elderly patients; and use during pregnancy and nursing. Successful adjuvant therapy of melanoma with high-dose IFN requires close compliance with the treatment regimen. Recommendations for the recognition and management of adverse events are designed to enable more patients to complete the full planned course of treatment.

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Section: Ocular Toxicitymentioning

confidence: 99%

Practical guidelines for the management of interferon‐α‐2b side effects in patients receiving adjuvant treatment for melanoma

Hauschild

Gogas

Tarhini

et al. 2008

Cancer

123

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“…These oc- www.TheOncologist.com ular changes can occur as early as 3 weeks to several months after drug therapy is started. There have been some cases of irreversible visual impairment despite discontinuation of HD-IFN, but these have been associated with poor visual acuity at presentation and AION [13,14]. In one reported case, no improvement in the IAR was observed despite aggressive treatment with acetylsalicylic acid, dexamethasone, heparin, and cyclosporine [14].…”

Section: Discussionmentioning

confidence: 99%

“…There have been some cases of irreversible visual impairment despite discontinuation of HD-IFN, but these have been associated with poor visual acuity at presentation and AION [13,14]. In one reported case, no improvement in the IAR was observed despite aggressive treatment with acetylsalicylic acid, dexamethasone, heparin, and cyclosporine [14]. Fortunately, these severe cases of IAR are rare, and in the majority of milder cases the retinal changes resolve with the discontinuation of interferon.…”

Section: Discussionmentioning

confidence: 99%

Retinopathy Associated with Adjuvant High-Dose Interferon-α2b in a Patient with Resected Melanoma: A Case Report and Review of the Literature

et al. 2012

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Interferon is the only accepted adjuvant treatment for patients with melanoma; hence, oncologists should be aware of the possibility of retinal abnormalities resulting from its use. Interferon-associated retinopathy in patients being treated for resected melanoma is a rare phenomenon with a proposed immunological basis. Patients are usually asymptomatic or have mild visual impairments, with cotton wool infarcts and hemorrhages. These symptoms and signs usually resolve with the discontinuation of interferon, but in a few severe presentations the visual impairments and retinal changes can be irreversible. The Oncologist 2012; 17:384 -387 CASEA healthy, 35-year-old woman was receiving high-dose adjuvant interferon-␣2b (HD-IFN) for a resected stage 3a superficial spreading cutaneous malignant melanoma of the right arm. She had received induction treatment of 33 million units (20 million units/m 2 ) of HD-IFN i.v. 5 days per week for 4 weeks, and maintenance therapy of 16 million units (10 million units/ m 2 ) s.c. 3 days per week had been initiated for a planned total of 11 months. Four months into treatment, she presented with painless blurred vision inferotemporal to fixation in her left eye. Other than her new visual symptoms, she did not have any other significant side effects that would warrant discontinuing her treatment. Moreover, she denied any headache, fever, diplopia, or orbital pain. On examination, her vital signs, including blood pressure, were normal. Her cardiovascular, respiratory, and abdominal examinations were unremarkable. Her remaining cranial nerves and neurological examinations were unremarkable. She had mild anemia (hemoglobin, 114 g/L; hematocrit, 0.347 L/L) and no thrombocytopenia. She was referred urgently to an ophthalmologist for evaluation. Her central vision was 6/6 in each eye without correction. Pupil reactions were normal. Examinations of the anterior segments, anterior chambers, optic discs, and retinal vasculature were all normal. Color vision was not tested. There were cotton wool infarcts between the optic disc and fovea in the left eye and along the superotemporal arcades in both eyes (Fig. 1A and 1B, arrows). There was a paracentral scotoma on Amsler grid testing in the left eye. The etiology of the retinopathy was felt to be associated with her HD-IFN and she was instructed to stop the agent immediately. Three weeks later, there was a marked reduction in the cotton wool spots (Fig. 1C and 1D, arrows), and by 10 weeks they had almost completely resolved. The left eye scotoma had also resolved. DISCUSSIONHD-IFN has been the standard adjuvant treatment for melanoma since researchers first demonstrated that it could produce longer relapse-free survival (RFS) and overall survival (OS)

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“…It is possible that the frequent ex posure to interferon induces the production of autoantibodies leading to the deposition of immune complexes in the retina (31) . It is also plausible that the deposition of inflammatory cytokines in the ar terial walls of the retina might be related to the develop ment of ophthalmological adverse events (103) .…”

Section: Discussionmentioning

confidence: 99%

Literature systematic review on the ophthalmological side effects of interferons

Fragoso¹,

Paggiaro²,

Mastromauro³

et al. 2011

Arq. Bras. Oftalmol.

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Interferons alpha and beta have been used worldwide for a few decades, altering the natural history of several severe diseases including hepatitis C, cancer and immu nemediated conditions such as multiple sclerosis. The adverse events profile of interferons is well established, but only isolated reports of ophthalmological compli ca tions of interferon therapy have been published. The objective of this study was to carry out a literature systematic review on the subject, bringing to light the need for ca reful ophthalmological monitoring of patients undergoing interferon treatment. Nearly 500 cases of ophthalmological complications related to interferon have been repor ted. The most frequent findings were soft exudates, hemorrhages and retina ischemia. Keywords BACKGROUNDInterferons are natural glycoproteins that have antiviral, antipro liferative and immune regulatory functions. There are several classes including interferon alpha, beta and gamma. Interferons alpha and beta are used worldwide in the treatment of several di seases including hepatitis C, cancer and immune-mediated condi tions such as multiple sclerosis. Due to the long-term use of interferons for most patients, the safety profile of these compounds is well known. Cutaneous(1) , hematological (2) , psychiatric (3,4) , endo crine (5) and hepatic (6) side effects of interferons have been reported. However, some side effects are specifically related to the eye, and a variety of ophthalmological diseases may arise from the use of inter ferons. Although recognised as relatively rare, ophthalmo lo gical complications due to interferons should be considered even if the patient is visually asymptomatic.The literature on the subject is restricted to case reports or a small series of cases. In order to better understand the most fre quent ophthalmological side effects of interferons and the outcome of these conditions, a literature systematic review was carried out.

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Severe loss of vision during adjuvant interferon alfa-2b treatment for malignant melanoma

Cited by 50 publications

References 3 publications

Practical guidelines for the management of interferon‐α‐2b side effects in patients receiving adjuvant treatment for melanoma

Practical guidelines for the management of interferon‐α‐2b side effects in patients receiving adjuvant treatment for melanoma

Retinopathy Associated with Adjuvant High-Dose Interferon-α2b in a Patient with Resected Melanoma: A Case Report and Review of the Literature

Literature systematic review on the ophthalmological side effects of interferons

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