Immune Checkpoint Inhibitor-Associated Optic Neuritis

Abstract

Immune checkpoint inhibitors (ICIs) are a group of systemically administered immunotherapy agents that enhance the adaptive immune response and now are used widely to treat many forms of cancer. 1 Dalvin L.A. Shields C.L. Orloff M. et al. Checkpoint inhibitor immune therapy: systemic indications and ophthalmic side effects. Retina. 2018; 38: 1063-1078 Crossref PubMed Scopus (176) Google Scholar They include monoclonal antibodies that block and inhibit cytotoxic T-lymphocyte associated antigen 4 (ipilimumab and tremelimumab), programmed cell death protein 1 (nivolumab, pembrolizumab, and cemiplimab), and programmed cell death ligand 1 (atezolizumab, avelumab, and durvalumab). Generally, ICIs potentiate the T-lymphocyte response, including reactivity against tumor cells. However, unrestrained T cells also can target normal tissue aberrantly and trigger a range of adverse inflammatory events, including ophthalmic and neurologic phenomena. 2 Kim J.M. Materin M.A. Sznol M. et al. Ophthalmic Immune-related adverse events of immunotherapy: a single-site case series. Ophthalmology. 2019; 126: 1058-1062 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Re: Francis et al.: Immune checkpoint inhibitor associated optic neuritis (Ophthalmology. 2020;127:1585-1589)OphthalmologyVol. 127Issue 11PreviewWe read the article by Francis et al1 describing 18 eyes of 11 patients with immune checkpoint inhibitor (ICI)-associated optic neuritis (ON). Having diagnosed and treated patients with ICI-associated ON, we understand the need for a larger series to clarify the presenting features and approach to treatment, as the available literature is very limited at this point. However, after reading this article, we would like to argue that many of the patients described likely did not have a diagnosis of ON. Full-Text PDF