Acute visual loss after ipilimumab treatment for metastatic melanoma

J Immunother Cancer. 2016 Oct 18:4:66. doi: 10.1186/s40425-016-0170-9. eCollection 2016.

Abstract

Background: Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs).

Case presentation: Here we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment. Furthermore, the patient experienced multiple complications from high dose steroids used to manage his IrAEs.

Conclusions: This case highlights the need for recognition of atypical immune mediated processes associated with newer checkpoint inhibitor therapies including ipilimumab.

Keywords: Checkpoint inhibitors; Immune; Ipilimumab; Melanoma; Optic neuritis; Side effects.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Antineoplastic Agents, Immunological / adverse effects*
  • Antineoplastic Agents, Immunological / therapeutic use
  • Biomarkers
  • Brain / pathology
  • CTLA-4 Antigen / antagonists & inhibitors
  • Fluorescein Angiography
  • Humans
  • Ipilimumab / adverse effects*
  • Ipilimumab / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / complications*
  • Melanoma / drug therapy
  • Melanoma / pathology
  • Middle Aged
  • Molecular Targeted Therapy / adverse effects
  • Neoplasm Metastasis
  • Optic Nerve / pathology
  • Vision Disorders / diagnosis*
  • Vision Disorders / etiology*
  • Vision Tests

Substances

  • Antineoplastic Agents, Immunological
  • Biomarkers
  • CTLA-4 Antigen
  • Ipilimumab