TY  - CHAP
M1  - Book, Section
TI  - Ocular Toxicity from Nivolumab
A1  - Viggars, Andrew
A1  - Jagdev, Satinder
A1  - Ralph, Christy
A1  - Stewart, Rosalind
A2  - Board, Ruth E.
A2  - Nathan, Paul
A2  - Newsom-Davis, Tom
A2  - Papa, Sophie
A2  - Johnson, Peter
Y1  - 2019
N1  - 
T2  - Problem Solving in Cancer Immunotherapy
AB  - A  59-year-old  woman  with  renal  cell  carcinoma  (RCC)  presented  to  the  medical  oncology  clinic.  Three  years  previously  she  had  undergone  a  radical  nephrectomy  for  a  T3N0M0  clear  cell  carcinoma.  She  had  no  history  of  autoimmune  disease  and  had  previously  been  otherwise  fit.She  was  initially  treated  with  interleukin  (IL)-2  therapy,  but  it  was  complicated  by  a  C2  vertebral  fracture,  after  which  she  proceeded  to  further  treatment  with  sunitinib.  An  initially  good  partial  response  was  maintained  for  30  months  despite  two  dose  reductions  due  to  toxicities.  Restaging  scans  at  30  months  found  further  disease  progression  and  she  commenced  nivolumab  therapy.After  two  cycles  of  nivolumab  the  patient  presented  with  sore,  red,  dry  eyes  (more  so  in  the  left,  where  her  vision  had  reduced  to  6/24  unaided,  6/12  pinhole)  and  polyarthropathy  involving  the  small  joints  of  the  hands  and  wrists.  Both  eyes  were  erythematous  on  examination.  An  urgent  ophthalmology  review  noted  blepharitis,  bilateral  conjunctival  injection,  and  a  marked  left  corneal  epitheliopathy  consistent  with  acute  dry  eye.  She  was  prescribed  hourly  preservative-free  topical  lubricants  and  a  lubricating  ointment  for  night-time.Three  weeks  later  her  symptoms  had  not  improved.  Her  vision  had  deteriorated  to  6/36  unaided,  6/18  pinhole  in  the  left  eye,  and  an  inferior  corneal  infiltrate  was  noted  typical  of  marginal  keratitis.  A  punctual  plug  was  inserted  into  the  left  lower  punctum;  she  was  commenced  on  topical  levofloxacin  six  times  a  day  and  topical  steroids  were  added  4  days  later.  Two  weeks  later,  oral  prednisolone  30  mg/day  was  commenced  for  ongoing  symptoms.  The  polyarthropathy  improved  rapidly  and  her  ocular  symptoms  gradually  resolved.  The  dose  of  oral  prednisolone  was  steadily  reduced  over  6  weeks.Re-challenge  with  nivolumab  was  discussed,  but  it  was  not  possible  as  her  performance  status  declined  prior  to  recommencing  treatment.What  is  the  evidence  for  nivolumab  treatment  in  RCC?What  are  the  differential  diagnoses  in  this  case?Which  ocular  and  orbital  toxicities  may  patients  experience  with  immunotherapy  treatments?How  are  ocular  toxicities  graded?What  is  the  management  of  ocular  and  orbital  toxicity  with  immunotherapy?  
SN  - 
PB  - EBN Health
CY  - New York, NY
Y2  - 2019/05/19
UR  - hemonc.mhmedical.com/content.aspx?aid=1160633517
ER  -