Syar Palwasha, Moussavi Sara, Torres-Caballa Carlos, Esmaeli Bita
Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
Taiwan J Ophthalmol. 2025 Mar 6;15(1):14-25. doi: 10.4103/tjo.TJO-D-24-00130. eCollection 2025 Jan-Mar.
The introduction of immune checkpoint inhibitors (ICIs) into clinical medicine has resulted in more robust response rates for various malignancies, including metastatic and locally advanced periocular and ocular tumors. Their increased utility constitutes a pivotal shift from invasive surgical treatments allowing patients to proceed with eye preserving therapies while also achieving local and metastatic tumor control. The aim of this review article is to provide a summary and updates on the current clinical utility of ICIs for conjunctival and periocular melanoma and squamous cell carcinoma, periocular Merkel cell carcinoma and periocular basal cell carcinoma resistant to BRAF inhibitors. A literature search was conducted on PubMed of programmed cell death protein 1 (nivolumab, pembrolizumab), PD-L1 (atezolizumab, avelumab, durvalumab), and CTLA-4 inhibitors (ipilimumab, tremelimumab) along with previously noted conjunctival and periocular tumors. While this article references several large clinical trials for cutaneous tumors, most of the ocular data are limited to case reports and series. Our overall review presents promising results with the usage of ICI for patients, noting an increased overall survival rate, clinical control of local and metastatic disease and decreased surgical morbidity, while avoiding orbital exenteration. These improvements have not come without considerations for adverse immune-related side effects and clinicians needs to be judicious is deciding between the overall efficacy and side effects.
免疫检查点抑制剂（ICI）引入临床医学后，各类恶性肿瘤，包括转移性和局部晚期眼周及眼部肿瘤的缓解率更高。其应用的增加构成了从侵入性手术治疗的关键转变，使患者能够接受保留眼球的治疗，同时实现局部和转移性肿瘤的控制。这篇综述文章的目的是总结和更新ICI目前在结膜和眼周黑色素瘤、鳞状细胞癌、眼周默克尔细胞癌以及对BRAF抑制剂耐药的眼周基底细胞癌中的临床应用情况。在PubMed上对程序性细胞死亡蛋白1（纳武单抗、帕博利珠单抗）、PD-L1（阿特珠单抗、阿维鲁单抗、度伐鲁单抗）和CTLA-4抑制剂（伊匹木单抗、曲美木单抗）以及先前提到的结膜和眼周肿瘤进行了文献检索。虽然本文引用了一些关于皮肤肿瘤的大型临床试验，但大多数眼部数据仅限于病例报告和系列研究。我们的全面综述显示，ICI用于患者有令人鼓舞的结果，注意到总生存率提高、局部和转移性疾病的临床控制以及手术发病率降低，同时避免了眼眶内容剜除术。这些改善并非没有考虑到免疫相关的不良副作用，临床医生在决定整体疗效和副作用时需要谨慎。
