A recent literature review published in Graefe’s Archive for Clinical and Experimental Ophthalmology analyzed the known neuro-ophthalmic complications of targeted cancer therapies and described corresponding management techniques.
Give me some background.
Targeted cancer therapies have allowed for the proliferation of anti-cancer treatments and improved cancer survival rates.
As more anti-cancer drugs are developed with broader indications, understanding the ocular adverse events associated with them is critical to providing high-quality care for patients.
While neuro-ophthalmic complications of these medications are uncommon, they can be vision-threatening and may involve other organ systems if not detected and treated early enough in the disease course.
Now talk about the study.
Investigators included studies from PubMed, Embase, and Web of Science that focused on any drugs that target specific molecules involved in the cancer disease process.
Studies were identified with the generic names of each drug and keywords for neuro-ophthalmic conditions; the prescribing information published by the FDA for each drug was included in the review.
Anti-cancer drugs included in the review were:
- Tyrosine kinase inhibitors
- Immune checkpoint inhibitors (ICIs)
- Proteasome inhibitors
- Antibody-drug conjugates
- Selective inhibitors of nuclear export
Findings?
Various classes of targeted anti-cancer drugs were found to cause neuro-ophthalmic adverse events.
For example, ICIs were linked with an assortment of immune-related adverse events, such as:
- Optic neuritis
- Ischemic optic neuropathy (ICI)
- Posterior reversible encephalopathy syndrome (PRES)
- Myasthenia gravis
Tell me more.
Anti-vascular endothelial growth factor (VEGF) therapies were found to induce posterior reversible leukoencephalopathy—which commonly presents with vision loss and can be fatal if not treated promptly.
Additionally, optic nerve disorders were associated with:
- Breakpoint cluster region-Abelson 1 (BCR-ABL1) inhibitors
- VEGF inhibitors
- Anaplastic lymphoma kinase (ALK) inhibitors
- Proteasome inhibitors
So how can doctors manage neuro-ophthalmic complications?
According to the study authors, “While measures such as corticosteroids can treat many of these complications, drug discontinuation is usually required.”
They added that this has important implications for an individual’s cancer treatment and prognosis, and requires multidisciplinary discussion.
And which patients are at risk of neuro-ophthalmic complications?
“Certain patients may be at a higher risk of developing neuro-ophthalmic complications, such as those with a history of neuro-ophthalmic or autoimmune conditions taking ICIs,” they wrote, “and this should be taken into account by oncologists when discussing treatment selection.”.
Take home.
The expansion of targeted cancer therapies has allowed patients to receive life-prolonging medications; however, neuro-ophthalmic complications can impact the duration of treatment depending on their severity.
Based on these study findings, clinicians treating patients with a history of targeted anti-cancer drugs may benefit from understanding potential neuro-ophthalmic complications to catch symptoms promptly, make a diagnosis, and initiate treatment before they can progress to being vision-threatening.