Wang Jian, Xiao Xiaoyue, Dong Xiaorong, Wu Gang, Wang Xinghua, Zhang Ruiguang
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Radiation Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Oncol. 2022 Aug 9;12:931074. doi: 10.3389/fonc.2022.931074. eCollection 2022.
Anti-PD-1/PD-L1 immunotherapy reactivates T-cell activity to boost the antitumor effect and may trigger autoimmune toxicity in various organ systems involving eyeball and periocular structures at the same time. The rarity of ocular immune-related adverse events should not prevent us from paying attention to this issue because of the bad consequences of visual impairment. This is the first case report of anti-PD-1 sintilimab-induced bilateral optic neuropathy in a 76-year-old man with squamous non-small cell lung cancer (NSCLC). The patient presented with sudden vision blurring without pain in both eyes after three therapeutic cycles of sintilimab plus chemotherapy. Based on the ophthalmic examination, laboratory, and radiological results, our patient was diagnosed with optic neuropathy complication secondary to anti-PD-1 sintilimab treatment. Consequently, sintilimab was held and systemic steroids were administered. The follow-up review showed that the vision recovered and the size of the primary tumor continued to decrease with the response assessment as the partial response. In conclusion, this case report suggested that patients with NSCLC undergoing anti-PD-1/PD-L1 therapy should be closely monitored for ophthalmic assessment and alert to the occurrence of sintilimab-induced optic neuropathy.
抗程序性死亡蛋白1（PD-1）/程序性死亡配体1（PD-L1）免疫疗法可重新激活T细胞活性以增强抗肿瘤作用，同时可能在涉及眼球和眼周结构的各个器官系统中引发自身免疫毒性。眼部免疫相关不良事件的罕见性不应使我们因视力损害的不良后果而忽视这一问题。本文首次报道了1例76岁鳞状非小细胞肺癌（NSCLC）男性患者在接受抗PD-1抗体信迪利单抗治疗后发生双侧视神经病变。该患者在接受信迪利单抗联合化疗三个疗程后，双眼突然出现无痛性视力模糊。根据眼科检查、实验室检查和影像学检查结果，我们的患者被诊断为抗PD-1抗体信迪利单抗治疗继发的视神经病变并发症。因此，停用了信迪利单抗并给予全身类固醇治疗。随访复查显示视力恢复，原发肿瘤大小持续缩小，疗效评估为部分缓解。总之，本病例报告提示，接受抗PD-1/PD-L1治疗的NSCLC患者应密切进行眼科评估监测，并警惕信迪利单抗诱发的视神经病变的发生。
