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

Theme: Uveitis
What: Uveitis
Part of: Uveitis II: Advancements in Uveitis Diagnosis and Management / Uvéite II: Avancées dans le diagnostic et la prise en charge de l’uvéite
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 714 B

Abstract

Purpose: As immune checkpoint inhibitors (ICI) are increasingly employed in cancer therapy, a staggering number of ICI-induced uveitis cases are reported. Diagnosis and management are often delayed due to barriers to recognizing it as a rare immune-related adverse event (IRAE). The present study aims to provide a comprehensive review of the mechanism, risk factors, clinical manifestations, diagnostic, and therapeutic approaches for uveitis induced by ICIs.

Study Design: This article is a literature review.

Methods: A comprehensive literature search of MEDLINE and EMBASE using keywords “uveitis”, “immune checkpoint inhibitors”, and generic drug names yielded 343 articles, of which 168 case reports, randomized clinical trials, and cohort studies were included. No date and language limitations were set.

Results: Uveitis is the most common ocular IRAE outside of dry eyes and has a prevalence of 0.3% to 6% among ICI users across clinical trials. A combination of factors – including HLA predisposition, cross-reactivity with cancer antigens, and the microbiome - play a role in the pathogenesis of ICI-induced uveitis. Melanoma, CTLA-4 inhibitors, and past ocular inflammation are key risk factors. Anterior uveitis is the most common clinical manifestation (around one case in three), but diagnostic imaging remains necessary to exclude posterior segment involvements, including Vogt-Koyanagi-Harada-like and birdshot-like posterior uveitis. Treatment modalities and prognosis are defined according to disease severity, as per the Common Terminology Criteria for Adverse Events. In low-grade uveitis, topical treatments suffice whereas most cases of higher-severity disease require systemic corticosteroids, immunosuppressive agents, or discontinuation of therapy.

Conclusions: Care must be taken when starting ICIs because of their side effects. Collaboration between ophthalmologists and oncologists is crucial to adequately manage ocular immune-related adverse events while reducing the risk of tumor progression.

Presenter(s)

Presenting Author: Valérie Gagné, Department of Medicine, Université Laval

Additional Author(s):

Anna (Huixin) Zhang, Prism Eye Institute and Department of Medicine, Université Laval

Kevin Yang Wu, Université de Sherbrooke

Lysa Houadj, Université de Sherbrooke

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