Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Immunol. 2023 Mar 23;14:1130238. doi: 10.3389/fimmu.2023.1130238. eCollection 2023.
To investigate the incidence of immune-related adverse events (irAEs) of immune checkpoint inhibitor (ICI) therapy and to report the clinical features, management, and outcomes of ophthalmic irAEs.
We retrospectively reviewed the medical records of patients who received ICI therapy from January 2016 to September 2022 at Peking Union Medical College Hospital and analyzed the incidence of systemic and ophthalmic adverse effects of this therapy.
Of 962 patients, 248 (25.8%) experienced irAEs. The first-year incidences of total irAEs and ophthalmic irAEs were 23.5% and 1.1%. The most common ICI received by the patients was pembrolizumab (373; 38.8%). Nearly half of the patients (477; 49.6%) had lung cancer. Combination therapy was associated with an increased incidence of irAEs without statistical significance. Patients with lung cancer presented with an increased incidence of total irAEs (p = 0.003) and ophthalmic irAEs (p = 0.032). Eleven patients had ophthalmic manifestations, including ophthalmoplegia (6/11), conjunctivitis (3/11), reactive cutaneous capillary endothelial proliferation (RCCEP) (1/11), and orbital inflammation (1/11). Eight patients had concomitant extra-ophthalmic irAEs. Furthermore, ICIs were discontinued in nine patients, and most ophthalmic manifestations were well controlled with topical and systemic steroids. Ten patients were treated with intravenous or oral steroids. However, cancer progression occurred in five out of eleven patients after the interruption of ICIs.
IrAEs are correlated with ICI regimens and underlying neoplasia. In our Chinese cohort, patients have a higher risk of ophthalmoplegia than uveitis. Early recognition and multidisciplinary consultation are crucial for optimal treatment of ophthalmic irAEs.
研究免疫检查点抑制剂（ICI）治疗的免疫相关不良事件（irAE）发生率，并报告眼部 irAE 的临床特征、管理和结局。
我们回顾性分析了 2016 年 1 月至 2022 年 9 月在北京协和医院接受 ICI 治疗的患者的病历，并分析了该治疗的全身和眼部不良反应发生率。
962 例患者中，248 例（25.8%）发生 irAE。总 irAE 和眼部 irAE 的第一年发生率分别为 23.5%和 1.1%。患者最常接受的 ICI 是 pembrolizumab（373 例；38.8%）。近一半患者（477 例；49.6%）患有肺癌。联合治疗与 irAE 发生率增加相关，但无统计学意义。肺癌患者总 irAE（p=0.003）和眼部 irAE（p=0.032）发生率增加。11 例患者出现眼部表现，包括眼肌麻痹（6/11）、结膜炎（3/11）、反应性皮肤毛细血管内皮增生症（RCCEP）（1/11）和眶内炎症（1/11）。8 例患者伴有眼部以外的 irAE。此外，9 例患者停用了 ICI，大多数眼部表现经局部和全身皮质类固醇治疗后得到良好控制。10 例患者接受了静脉或口服皮质类固醇治疗。然而，在中断 ICI 后，11 例患者中有 5 例发生了癌症进展。
irAE 与 ICI 方案和基础肿瘤有关。在我们的中国队列中，患者发生眼肌麻痹的风险高于葡萄膜炎。早期识别和多学科会诊对于眼部 irAE 的最佳治疗至关重要。
