Various clinical presentations of uveitis associated with durvalumab treatment

Vrabic, Nika; Fakin, Ana; Mekjavic, Polona Jaki; Janzic, Urska; Vrankar, Martina; Valentincic, Natasa Vidovic

Various clinical presentations of uveitis associated with durvalumab treatment

Radiology and Oncology

Volume 56 (2022): Issue 2 (June 2022)

By:

Nika Vrabic, Ana Fakin, Polona Jaki Mekjavic, Urska Janzic, Martina Vrankar and Natasa Vidovic Valentincic

Open Access

|Apr 2022

Figures & Tables

Case I. Fundoscopy, at presentation, on one-week and five-week follow-up. Follow-up images show diminishment of vitreous haze and regression of optic disc swelling.OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)

Case I. Optical coherence tomography (OCT) of optic discs. Optic disc drusen at presentation and on a five-week follow-up. No alteration in optic disc drusen size is visible. Up images show diminishment of vitreous haze and regression of optic disc swelling.OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)

Case I. Fluorescein angiography at presentation. Early and late frames. Contrast blockage in the upper temporal part of the right optic disc (white arrow), corresponding to a peripapillary haemorrhage. Hypofluorescent dots (black arrow) corresponded to hyperreflective spots on optical coherence tomography (OCT). Fluorescein angiography five weeks on methylprednisolone treatment. Early and late frames. Diminishment of the contrast blockage in the upper temporal part of the right optic disc (white arrow) corresponding to a peripapillary haemorrhage. Hypofluorescent dots (black arrow) are less prominent.OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)

Case I. Optical coherence tomography (OCT) of optic discs, at presentation, one week on methylprednisolone treatment, five weeks on methylprednisolone treatment. Follow-up shows regression of optic disc swelling.OD(R) = oculus dexter (right); OS(L) = oculus sinister (left)

Case II. (A) Fundoscopy, prior to non-small cell lung cancer diagnosis in 2013: posterior pole and peripheral retinal changes. (B) Colour fundus photography at presentation in March 2021: multiple flat, grey-white lesions (black arrows) are visible at presentation. (C) Three weeks on methylprednisolone treatment in April 2021: a diminishment of lesions (white arrows) is observed.OD = oculus dexter; OS(L) = oculus sinister

Case II. (A) Macular optical coherence tomography (OCT) presentation and (B) two weeks on methylprednisolone treatment. Loss of ellipsoid zone and hyperreflective haze in outer plexiform and outer nuclear layers is evident at presentation. Indocyanine angiography at presentation shows hypofluorescent lesions corresponding to ellipsoid zone disruptions (white arrows). Two weeks on methylprednisolone treatment ellipsoid zone appears granular.OD = oculus dexter; OS(L) = oculus sinister

Case II. Fluorescein angiography at presentation, early and late frames. Note surface capillary net dilatation and late staining of the papilla and hypofluorescent areas on the posterior pole and periphery. Indocyanine angiography at presentation showing hypofluorescent lesions.OD = oculus dexter; OS(L) = oculus sinister

Case II. Fundus autofluorescence images at presentation show no pathologic changes. Hyperautofluorescent spots are visible three weeks on methylprednisolone treatment.AF = fundus autofluorescence; OD = oculus dexter; OS(L) = oculus sinister

Published cases reporting uveitis secondary to durvalumab (PD-L1 inhibitor) treatment

Author, year	Number of cases reported	Indication	Ocular inflammation specification (% eyes)	Treatment	Discontinuing immune checkpoint inhibitor
Dow et al. 2020⁶	3	n/a	Anterior uveitis 80%Posterior uveitis 20%	Local corticosteroidSystemic corticosteroid	No
Parikh et al., 2020⁷	1	Non-small cell lung cancer	Anterior uveitis	Local corticosteroid	Yes
Andrade et al., 2020⁸	1	Non-small cell lung cancer	Retinal vasculitis	Systemic corticosteroid	Yes
Vrabic et al., 2021	2	Small cell lung cancer, non-small cell lung cancer	Intermediate uveitis, Posterior uveitis	Systemic corticosteroid	Yes

Published cases reporting uveitis and optic disc oedema/papillitis secondary to other immune checkpoint inhibitors

Author, year	Immune checkpoint inhibitor	Target receptor	Cancer diagnosis	Clinical findings at presentation	Complications	Initial treatment	Discontinuing immune checkpoint inhibitor
Hahn et al., 2016⁹	Ipilimumab	CTLA-4	Malignant melanoma	AC inflammation, keratic precipitates	Panuveitis, papillitis, intraretinal, subfoveal fluid	Topical prednisolone acetate, brimonidine tartrate timolol maleate, oral prednisolone 20 mg/day	Discontinued
Aaberg et al., 2017¹⁰	Pembrolizumab	PD-1	Uveal melanoma	AC inflammation, vitreous cells and haze	Optic disc oedema, posterior uveitis, retinal vasculitis	Intraocular dexamethasone implant	No.
Wang et al., 2019¹¹	Nivolumab	PD-1	Renal carcinoma	AC inflammation, keratoprecipitates, posterior synechiae, vitreous floaters	Panuveitis, papillitis, serous retinal detachment	Intravenous methylprednisolone 500 mg/day, followed by oral prednisolone 30 mg/day tapered over 2 months; recurrence of uveitis managed with periocular methylprednisolone, and intraocular dexamethasone implant	Discontinued, resumed 6 weeks after discontinuation, recurrence of uveitis 2 weeks after resumption
Reid et al., 2018¹²	Pembrolizumab	PD-1	Malignant melanoma	AC vitreous inflammation, cells, choroidal thickening, posterior synechiae	Panuveitis, optic disc oedema, hypotony	Oral prednisolone 75 mg/day 7 days, tapered over 3 weeks	Discontinued after 12 months commenced on nivolumab therapy
Navarro- Perea et al., 2019¹³	Pembrolizumab	PD-1	Malignant melanoma	AC inflammation, irido-crystalline synechiae	Optic disc oedema	Topical dexamethasone, cyclopentolate, tropicamide, phenylephrine, oral prednisolone 40 mg/day tapered over 2 months	Discontinued, replaced by vemurafenib and cobimetinib
Sun et al., 2020⁵	Nivolumab	PD-1	Malignant melanoma	AC inflammation, vitreous cells, and haze	Optic disc oedema, ocular hypertension	Topical prednisolone acetate, oral prednisolone 60 mg/day	n/a
Sun 2020et ⁵ al.,	Pembrolizumab	PD-1	Malignant melanoma	AC inflammation	Hypotony, Papillitis	Topical difluprednate, subtenon triamcinolone acetonide	n/a
Sun et al., 2020⁵	Ipilimumab	PD-1	Malignant melanoma	AC inflammation, vitreous cells	Macular oedema, Papillitis	Tiamcinolonetransseptal followed by retrobulbar)	n/a
Kim et al., 2020¹⁴	Pembrolizumab	PD-1	Renal carcinoma	n/a	Panuveitis, papillitis	Topical steroid, posterior subtenon triamcinolone injection	Discontinued
Kim 2020et ¹⁴ al.,	Pembrolizumab	PD-1	Uveal melanoma	n/a	Panuveitis, papillitis	Systemic steroid	Discontinued
Kim 2020et ¹⁴ al.	Pembrolizumab	PD-1	Lung cancer	n/a	Panuveitis, uveal effusion papillitis,	Systemic steroid	Discontinued
Kikuchi et al. 2020¹⁵	Nivolumab	PD-1	Hypopharyngeal cancer	Granulomatous mutton-fat keratic precipitates, AC inflammation, posterior synechiae	Panuveitis, papillitis, serous retinal detachment; Vogt- Koyanagi-Harada disease-like uveitis	Sub-tenon triamcinolone acetonide, followed by methylprednisolone 1000 mg/day 3 days, followed by oral methylprednisolone 50 mg/day tapered by 5 mg every week	Discontinued due to the patient’s deteriorating health
Vrabic et al.	durvalumab	PDL-1	NSCLC	AC inflammation, vitreous cells	Intermediate uveitis, optic dics oedema	Systemic steroid 500 mg/day 3 days, followed by oral methylprednisolone 48 mg/day tapered over 6 weeks	Discontinued

DOI: https://doi.org/10.2478/raon-2022-0007 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099

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Language: English

Page range: 129 - 137

Submitted on: Nov 24, 2021

Accepted on: Jan 10, 2022

Published on: Apr 12, 2022

Published by: Association of Radiology and Oncology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 times per year

Keywords:

durvalumab,

uveitis,

optic disc oedema,

immune checkpoint inhibitor,

Related subjects:

Haematology, oncology,

Radiology

© 2022 Nika Vrabic, Ana Fakin, Polona Jaki Mekjavic, Urska Janzic, Martina Vrankar, Natasa Vidovic Valentincic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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Various clinical presentations of uveitis associated with durvalumab treatment

Figures & Tables

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Published cases reporting uveitis secondary to durvalumab (PD-L1 inhibitor) treatment

Published cases reporting uveitis and optic disc oedema/papillitis secondary to other immune checkpoint inhibitors

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