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Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients.

Publication ,  Conference
Sagiv, O; Kandl, TJ; Thakar, SD; Thuro, BA; Busaidy, NL; Cabanillas, M; Jimenez, C; Dadu, R; Graham, PH; Debnam, JM; Esmaeli, B
Published in: Ophthalmic Plast Reconstr Surg
2019

PURPOSE: To describe thyroid eye disease (TED)-like orbital inflammatory syndrome in 3 cancer patients treated with immune checkpoint inhibitors. METHODS: All consecutive patients treated by the senior author who were receiving immune checkpoint inhibitors and developed TED-like orbital inflammation were included. RESULTS: Three cancer patients treated with immune checkpoint inhibitors developed orbital inflammation. The first patient was treated with a combination of a cytotoxic T-lymphocyte antigen-4 inhibitor and a programmed cell death protein 1 inhibitor and developed TED-like orbital inflammation with normal thyroid function and antibody levels. The second patient had a previous diagnosis of Graves disease without TED, and developed TED soon after initiating treatment with a programmed cell death protein 1 inhibitor. The third patient developed acute hyperthyroidism with symptomatic TED following treatment with an investigational cytotoxic T-lymphocyte antigen-4 inhibitor agent. All 3 patients were managed with either systemic steroids or observation, with resolution of their symptoms and without the need to halt immune checkpoint inhibitor treatment for their cancer. DISCUSSION AND CONCLUSIONS: TED-like orbital inflammation may occur as a side effect of immune checkpoint inhibitor therapy with anti-cytotoxic T-lymphocyte antigen-4 or anti-PD-1 inhibitors. To the best of their knowledge, this is the first reported case of TED as a result of programmed cell death protein 1 inhibitor monotherapy. All 3 patients were treated with systemic steroids and responded quickly while continuing treatment with immune checkpoint inhibitors for their cancer. With increasing use of this class of drugs, clinicians should be familiar with the clinical manifestations and treatments for this adverse reaction.

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Published In

Ophthalmic Plast Reconstr Surg

DOI

EISSN

1537-2677

Publication Date

2019

Volume

35

Issue

1

Start / End Page

50 / 52

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radioimmunotherapy
  • Programmed Cell Death 1 Receptor
  • Ophthalmology & Optometry
  • Oculomotor Muscles
  • Neoplasms
  • Middle Aged
  • Male
  • Humans
  • Graves Ophthalmopathy
 

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Sagiv, O., Kandl, T. J., Thakar, S. D., Thuro, B. A., Busaidy, N. L., Cabanillas, M., … Esmaeli, B. (2019). Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients. In Ophthalmic Plast Reconstr Surg (Vol. 35, pp. 50–52). United States. https://doi.org/10.1097/IOP.0000000000001161
Sagiv, Oded, Thomas J. Kandl, Sudip D. Thakar, Bradley A. Thuro, Naifa L. Busaidy, Maria Cabanillas, Camilo Jimenez, et al. “Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients.” In Ophthalmic Plast Reconstr Surg, 35:50–52, 2019. https://doi.org/10.1097/IOP.0000000000001161.
Sagiv O, Kandl TJ, Thakar SD, Thuro BA, Busaidy NL, Cabanillas M, et al. Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients. In: Ophthalmic Plast Reconstr Surg. 2019. p. 50–2.
Sagiv, Oded, et al. “Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients.Ophthalmic Plast Reconstr Surg, vol. 35, no. 1, 2019, pp. 50–52. Pubmed, doi:10.1097/IOP.0000000000001161.
Sagiv O, Kandl TJ, Thakar SD, Thuro BA, Busaidy NL, Cabanillas M, Jimenez C, Dadu R, Graham PH, Debnam JM, Esmaeli B. Extraocular Muscle Enlargement and Thyroid Eye Disease-like Orbital Inflammation Associated with Immune Checkpoint Inhibitor Therapy in Cancer Patients. Ophthalmic Plast Reconstr Surg. 2019. p. 50–52.

Published In

Ophthalmic Plast Reconstr Surg

DOI

EISSN

1537-2677

Publication Date

2019

Volume

35

Issue

1

Start / End Page

50 / 52

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Radioimmunotherapy
  • Programmed Cell Death 1 Receptor
  • Ophthalmology & Optometry
  • Oculomotor Muscles
  • Neoplasms
  • Middle Aged
  • Male
  • Humans
  • Graves Ophthalmopathy