Association of Cancer Immunotherapy with Acute Macular Neuroretinopathy and Diffuse Retinal Venulitis

Leisha A. Emens, S. Lindsey Davis, Scott C.N. Oliver, Christopher H. Lieu, Ashvini Reddy, Sharon Solomon, Lingmin He, Roland Morley, Marcella Fassò, Andrea Pirzkall, Hina Patel, Carol O'Hear, Daniela Ferrara

Research output: Contribution to journalArticle

Abstract

Importance: Checkpoint inhibition in cancer immunotherapy related to T-cell-driven mechanisms of action associated with acute macular neuroretinopathy (AMN) and diffuse retinal venulitis, an adverse event not previously described, is reported here. Objective: To describe 2 patients who developed ophthalmologic events after treatment with the programmed death 1 axis inhibitor, atezolizumab. Design, Setting, and Participants: Retrospective review of 2 patients treated with atezolizumab for metastatic breast cancer and colon cancer, respectively, who presented with AMN and diffuse retinal venulitis conducted at 2 tertiary medical centers. Main Outcomes and Measures: Multimodal imaging including near infrared, optical coherence tomography, and fluorescein angiography were used to characterize retinal vascular abnormalities. Results: Based on optical coherence tomography and multimodal imaging findings, the clinical diagnosis of AMN associated with diffuse retinal venulitis was made in these 2 patients receiving atezolizumab. Conclusions and Relevance: While only 2 cases of patients receiving the programmed death ligand 1 inhibitor atezolizumab who experienced AMN and diffuse retinal venulitis are described here, these findings suggest that patients receiving programmed death 1 axis inhibitor therapies may need to be monitored for unexpected immune-related ocular toxicity including abnormalities of the microvasculature and large retinal vessels. Further studies might investigate the potential mechanisms of retinal vascular changes associated with these therapies.

Original languageEnglish (US)
JournalJAMA Ophthalmology
DOIs
StateAccepted/In press - Jan 1 2018

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Immunotherapy
Retinal Vessels
Multimodal Imaging
Optical Coherence Tomography
Neoplasms
Colonic Neoplasms
Fluorescein Angiography
Microvessels
Therapeutics
Outcome Assessment (Health Care)
Breast Neoplasms
Ligands
T-Lymphocytes
MPDL3280A

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Association of Cancer Immunotherapy with Acute Macular Neuroretinopathy and Diffuse Retinal Venulitis. / Emens, Leisha A.; Davis, S. Lindsey; Oliver, Scott C.N.; Lieu, Christopher H.; Reddy, Ashvini; Solomon, Sharon; He, Lingmin; Morley, Roland; Fassò, Marcella; Pirzkall, Andrea; Patel, Hina; O'Hear, Carol; Ferrara, Daniela.

In: JAMA Ophthalmology, 01.01.2018.

Research output: Contribution to journalArticle

Emens, LA, Davis, SL, Oliver, SCN, Lieu, CH, Reddy, A, Solomon, S, He, L, Morley, R, Fassò, M, Pirzkall, A, Patel, H, O'Hear, C & Ferrara, D 2018, 'Association of Cancer Immunotherapy with Acute Macular Neuroretinopathy and Diffuse Retinal Venulitis', JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2018.5191
Emens, Leisha A. ; Davis, S. Lindsey ; Oliver, Scott C.N. ; Lieu, Christopher H. ; Reddy, Ashvini ; Solomon, Sharon ; He, Lingmin ; Morley, Roland ; Fassò, Marcella ; Pirzkall, Andrea ; Patel, Hina ; O'Hear, Carol ; Ferrara, Daniela. / Association of Cancer Immunotherapy with Acute Macular Neuroretinopathy and Diffuse Retinal Venulitis. In: JAMA Ophthalmology. 2018.
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abstract = "Importance: Checkpoint inhibition in cancer immunotherapy related to T-cell-driven mechanisms of action associated with acute macular neuroretinopathy (AMN) and diffuse retinal venulitis, an adverse event not previously described, is reported here. Objective: To describe 2 patients who developed ophthalmologic events after treatment with the programmed death 1 axis inhibitor, atezolizumab. Design, Setting, and Participants: Retrospective review of 2 patients treated with atezolizumab for metastatic breast cancer and colon cancer, respectively, who presented with AMN and diffuse retinal venulitis conducted at 2 tertiary medical centers. Main Outcomes and Measures: Multimodal imaging including near infrared, optical coherence tomography, and fluorescein angiography were used to characterize retinal vascular abnormalities. Results: Based on optical coherence tomography and multimodal imaging findings, the clinical diagnosis of AMN associated with diffuse retinal venulitis was made in these 2 patients receiving atezolizumab. Conclusions and Relevance: While only 2 cases of patients receiving the programmed death ligand 1 inhibitor atezolizumab who experienced AMN and diffuse retinal venulitis are described here, these findings suggest that patients receiving programmed death 1 axis inhibitor therapies may need to be monitored for unexpected immune-related ocular toxicity including abnormalities of the microvasculature and large retinal vessels. Further studies might investigate the potential mechanisms of retinal vascular changes associated with these therapies.",
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