Kiraly Peter, Groznik Alenka Lavrič, Valentinčič Nataša Vidovič, Mekjavić Polona Jaki, Urbančič Mojca, Ocvirk Janja, Mesti Tanja
Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, SI-1000 Ljubljana, Slovenia.
Department of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia.
World J Clin Cases. 2022 Jul 6;10(19):6536-6542. doi: 10.12998/wjcc.v10.i19.6536.
Immune checkpoint inhibitors have revolutionized the treatment of patients with unresectable metastatic malignant melanoma. In addition to systemic side effects, several usually mild ocular adverse effects have been reported. We report a case of rarely reported vision-threatening bilateral panuveitis with serous retinal detachment, thickened choroid, and chorioretinal folds associated with dabrafenib and trametinib targeted therapy for B-Raf proto-oncogene serine/threonine kinase (BRAF) mutant metastatic cutaneous melanoma.
A 59-year-old female patient with metastatic melanoma treated with dabrafenib and trametinib presented with blurry vision and central scotoma lasting for 3 d in both eyes. Clinical examination and multimodal imaging revealed inflammatory cells in the anterior chamber, mild vitritis, bullous multiple serous retinal detachments, and chorioretinal folds in both eyes. Treatment with dabrafenib and trametinib was suspended, and the patient was treated with topical and intravenous corticosteroids followed by oral corticosteroid treatment with a tapering schedule. One and a half months after the disease onset, ocular morphological and functional improvement was noted. Due to the metastatic melanoma dissemination, BRAF/mitogen-activated protein kinase inhibitors were reintroduced and some mild ocular adverse effects reappeared, which later subsided after receiving oral corticosteroids.
Patients on combination therapy with dabrafenib and trametinib may rarely develop severe bilateral panuveitis with a good prognosis. Further studies have to establish potential usefulness of ophthalmological examination for asymptomatic patients. Furthermore, appropriate guidelines for managing panuveitis associated with dabrafenib and trametinib should be established.
免疫检查点抑制剂彻底改变了不可切除转移性恶性黑色素瘤患者的治疗方式。除全身副作用外，还报告了几种通常较为轻微的眼部不良反应。我们报告了1例罕见的、有视力威胁的双侧葡萄膜炎病例，伴有浆液性视网膜脱离、脉络膜增厚和脉络膜视网膜皱褶，与达拉非尼和曲美替尼靶向治疗B-Raf原癌基因丝氨酸/苏氨酸激酶（BRAF）突变的转移性皮肤黑色素瘤有关。
1例接受达拉非尼和曲美替尼治疗的转移性黑色素瘤女性患者，双眼出现视力模糊和中心暗点，持续3天。临床检查和多模态成像显示双眼前房有炎性细胞、轻度玻璃体炎、多发性大疱性浆液性视网膜脱离和脉络膜视网膜皱褶。暂停达拉非尼和曲美替尼治疗，患者接受局部和静脉注射皮质类固醇治疗，随后口服皮质类固醇并逐渐减量。发病1个半月后，眼部形态和功能有所改善。由于转移性黑色素瘤扩散，重新使用BRAF/丝裂原活化蛋白激酶抑制剂，再次出现一些轻度眼部不良反应，接受口服皮质类固醇治疗后症状缓解。
接受达拉非尼和曲美替尼联合治疗的患者可能很少发生严重的双侧葡萄膜炎，预后良好。需要进一步研究确定眼科检查对无症状患者的潜在作用。此外，应制定与达拉非尼和曲美替尼相关的葡萄膜炎管理的适当指南。
