Intraocular Inflammation Associated with New Therapies for Cutaneous Melanoma – Case Series and Review

Abstract

Background. In advanced cutaneous melanoma, new systemic therapies include immunotherapy by checkpoint inhibition and targeted inhibition of the mitogen-activated protein kinase pathway; these are becoming increasingly well established. We describe the clinical presentation of uveitis in three patients with concomitant systemic melanoma treatment.

History and Signs. Three patients with metastatic melanoma receiving systemic therapy (ipilimumab, vemurafenib) presented at our institution with a short history of ocular symptoms. Clinical findings included anterior uveitis, intermediate uveitis, disc swelling, inflammatory choroidal lesions and retinal vasculitis.

Therapy and Outcome. All three patients responded well to local and/or systemic steroid treatment. In one case, the systemic anti-cancer drug was discontinued after the onset of uveitis.

Conclusions. Ocular inflammation may occur in the setting of systemic melanoma therapy. Presentations of uveitis include Vogt-Koyanagi-Harada-like syndromes. Ocular inflammation can usually be controlled by topical and sometimes systemic corticosteroid therapy. However, treatment guidelines are not established and management of these patients demands close cooperation with the oncologist.

Zusammenfassung

Hintergrund. Neue systemische Therapien finden zunehmenden Einsatz in der Behandlung fortgeschrittener Melanomerkrankungen. Dazu gehören Therapien, welche die Immunantwort modulieren oder spezifisch in intrazelluläre Signalwege eingreifen. Wir beschreiben die klinische Präsentation uveitischer Erkrankungen bei 3 Patienten, welche gleichzeitig eine systemische Melanombehandlung erhalten haben.

Anamnese und Befund. Drei Patienten mit einer systemischen Melanomtherapie (Ipilimumab, Vemurafenib) haben sich in unserer Klinik aufgrund okulärer Beschwerden vorgestellt. Es zeigten sich in unterschiedlicher Kombination anteriore und intermediäre Uveitis, Papillenschwellung, entzündliche choroidale Läsionen und retinale Vaskulitis.

Therapie und Verlauf. Alle 3 Patienten haben auf lokale und/oder systemische Steroide ein gutes Ansprechen gezeigt. In 1 Fall wurde die zugrundeliegende systemische Therapie wegen der okulären Komplikationen abgesetzt.

Schlussfolgerungen. Im Rahmen systemischer Melanomtherapien können intraokulare Entzündungen auftreten, die sich unter anderem mit einem Vogt-Koyanagi-Harada-Syndrom ähnlichen Bild manifestieren. Therapeutisch werden meist lokale und manchmal auch systemische Steroide eingesetzt. Allgemeine Behandlungsrichtlinien sind aber noch nicht etabliert und im Einzelfall ist eine enge Zusammenarbeit mit dem behandelnden Onkologen erforderlich.

Key words

ocular side effects - uveitis - intraocular inflammation - Vogt-Koyanagi-Harada - ipilimumab - vemurafenib - CTLA-4-inhibition - BRAF-inhibition - immune-related adverse events

Schlüsselwörter

okuläre Nebenwirkungen - Uveitis - intraokulare Entzündung - Vogt-Koyanagi-Harada - Ipilimumab - Vemurafenib - CTLA-4-Inhibition - BRAF-Inhibition

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