Barmas-Alamdari Daniel, Jiao George, Lieberman Ronni
Department of Ophthalmology, Northwell Health, New York, NY, United States.
Department of Ophthalmology, Mount Sinai, New York, NY, United States.
Front Ophthalmol (Lausanne). 2024 Jan 22;3:1247296. doi: 10.3389/fopht.2023.1247296. eCollection 2023.
Modern chemotherapeutic agents continue to evolve as modern monoclonal antibody treatments are designed to directly target proteins, enzymes, and focal loci. A particular class of these medications, fibroblast growth factor (FGFR) inhibitors, specifically pemigatinib (Pemazyre; Incyte), has been approved by the US Food and Drug Administration since April 2020 for the treatment of advanced or metastatic cholangiocarcinoma. As it is a relatively new medication, its side-effect profile is manifesting in active clinical practice. The presence of FGFR receptors in the retinal pigment epithelium makes the retina susceptible to potential adverse effects secondary to pemigatinib use.
A 69-year-old African-American male with a tumor mutation burden 3 (TMB-3) metastatic adenocarcinoma of the liver from primary cholangiocarcinoma, who was undergoing chemotherapy with pemigatinib, was found to have asymptomatic bilateral subretinal fluid accumulation. Serial monitoring with optical coherence tomography (OCT) demonstrated complete resolution of the subretinal fluid while off-cycle and asymptomatic re-accumulation of subretinal fluid while on-cycle, with no significant changes in visual acuity.
Subretinal fluid accumulation secondary to pemigatinib may develop during the active treatment cycles without causing any significant visual symptoms for the patient. Serial monitoring demonstrates fluctuations of subretinal fluid during the patient's on- and off-cycles. This case strengthens the current guidelines for continuing pemigatinib in asymptomatic patients found to have subretinal fluid. Further studies are warranted to identify patients who may be at higher risk for developing subretinal fluid.
随着现代单克隆抗体治疗被设计用于直接靶向蛋白质、酶和焦点基因座，现代化疗药物不断发展。这类药物中的一种特殊类型，即成纤维细胞生长因子（FGFR）抑制剂，特别是培米替尼（Pemazyre；因赛特公司），自2020年4月起已被美国食品药品监督管理局批准用于治疗晚期或转移性胆管癌。由于它是一种相对较新的药物，其副作用在积极的临床实践中逐渐显现。视网膜色素上皮中FGFR受体的存在使视网膜易受培米替尼使用继发的潜在不良反应影响。
一名69岁的非裔美国男性，患有原发性胆管癌伴肿瘤突变负荷3（TMB - 3）的肝转移性腺癌，正在接受培米替尼化疗，被发现双侧视网膜下液无症状性积聚。通过光学相干断层扫描（OCT）进行的连续监测显示，在停药周期时视网膜下液完全消退，而在用药周期时视网膜下液无症状性再次积聚，视力无明显变化。
培米替尼继发的视网膜下液积聚可能在积极治疗周期中出现，而不会给患者造成任何明显的视觉症状。连续监测显示患者在用药和停药周期中视网膜下液有波动。该病例强化了目前对于在发现有视网膜下液的无症状患者中继续使用培米替尼的指南。有必要进行进一步研究以确定可能发生视网膜下液风险较高的患者。
