Dilemma for cancer patients as life-saving meds are tied to vision loss

May 18, 2018 by Serena Gordon, Healthday Reporter

(HealthDay)—A newer type of cancer treatment may offer the chance of longer survival, but the drugs could also trigger new side effects, such as vision problems.

New research reports on three cases of a potentially vision-threatening eye condition called uveal effusion that developed after taking immunotherapy. Immunotherapy uses a person's own immune system to fight cancer.

Uveal effusion occurs when the eye becomes inflamed and fluid collects in the three layers that make up the wall of the eye, the researchers said. This can cause blurred vision, and even vision loss, according to the American Academy of Ophthalmology.

But though this side effect sounds worrisome, the senior author of the new research said there's no need to panic.

"No one should stop their medications," said Dr. Hakan Demirci, an associate professor of ophthalmology at the University of Michigan's Kellogg Eye Center.

"First, this is a very rare complication. The chance of developing ocular side effects or uveal effusion is very low. Second, the patients who are on this medication usually have very serious, life-threatening cancer. It is very important to keep using the medication for tumor control," he said.

And, in two of the three cases, the eye problems went away when the drug was stopped for a while. The third patient continued taking the drug, but died from his cancer.

All three patients were being treated for cancer that had spread to other parts of the body (one had lung cancer and two had melanoma). One was a 68-year-old man who had blurred vision and redness in his left eye. The second was a 52-year-old man who had redness and pain in both eyes, and the third was an 85-year-old man who had swelling in his left eye.

All three men were taking a type of immunotherapy called immune checkpoint inhibitors.

Normally, the immune system only goes after cells it recognizes as foreign. It uses molecules known as checkpoints that need to be activated or inactivated to prevent an attack on normal, healthy cells, according to the American Cancer Society (ACS).

But cancer sometimes uses these checkpoints to avoid detection by the immune system, the ACS explains. Immune checkpoint inhibitors allow the immune system to "see" the cancer hiding behind the checkpoint. If the checkpoint is turned off, the drugs may also allow the immune system to see normal cells as foreign.

Dr. Catherine Diefenbach is an American Society of Clinical Oncology expert and assistant professor of medicine at the NYU Langone Perlmutter Cancer Center in New York City.

"When you activate the immune system, you can see common and uncommon side effects," she said.

The treatments improve survival odds for patients with advanced melanoma and hard-to-treat cancers of the bladder, kidney and lung.

Examples of immune checkpoint inhibitors include pembrolizumab (Keytruda), nivolumab (Opdivo), atezolizumab (Tecentriq), avelumab (Bavencio) and durvalumab (Imfinzi), according to the ACS.

In the three cases reported, Demirci said the began about three to eight weeks after patients received the drugs. Each received a different drug from this class of medications.

Demirci and Diefenbach both said there's no known way to prevent this side effect from happening.

"We don't know how to protect the eyes. I am sure we will figure it out as we understand more," Demirci said.

Diefenbach said it's always important to let your doctor know if you're experiencing any side effects. "If something strange is happening, let your doctor know. Don't minimize an unusual complaint," she added.

Both experts also advised patients to continue their medications until they speak with their doctor.

The case reports were published online recently in JAMA Ophthalmology.

Explore further: Ophthalmologists link immunotherapy with a serious eye condition

More information: Hakan Demirci, M.D., associate professor, ophthalmology, Kellogg Eye Center, University of Michigan, Ann Arbor; Catherine Diefenbach, M.D., American Society of Clinical Oncology expert, and assistant professor of medicine, NYU Langone Perlmutter Cancer Center, New York City; April 12, 2018, JAMA Ophthalmology, online

Learn more about immunotherapy for cancer from the American Cancer Society.

Related Stories

Ophthalmologists link immunotherapy with a serious eye condition

May 7, 2018
New immunotherapy treatments offer a remarkable chance for survival for patients with advanced melanoma and hard-to-treat cancers of the bladder, kidney and lung.

Technology holds personalised cancer vaccine breakthrough

April 10, 2018
University of Queensland researchers have developed a vaccine delivery technology that enables treatment to be tailored precisely for different cancers.

Immune therapy scores big win against lung cancer in study

April 16, 2018
For the first time, a treatment that boosts the immune system greatly improved survival in people newly diagnosed with the most common form of lung cancer. It's the biggest win so far for immunotherapy, which has had much ...

Cancer immunotherapy may work better in patients with specific genes

December 15, 2017
Cancer cells arise when DNA is mutated, and these cells should be recognized as "foreign" by the immune system. However, cancer cells have found ways to evade detection by the immune system.

Cancer immunotherapy found safe in patients with rheumatologic diseases

January 24, 2018
In the largest single-center study of patients with rheumatologic diseases who were prescribed modern cancer immunotherapy with what are called immune checkpoint inhibitors, only a minority of patients experienced a flare ...

Quickly spotting rare side effects from immunotherapy

January 3, 2018
Immunotherapy, which uses the body's own immune system to fight disease, is transforming the treatment of several types of cancers. Severe adverse effects can result from these groundbreaking cancer treatments, however, and ...

Recommended for you

Why some cancers affect only young women

October 19, 2018
Among several forms of pancreatic cancer, one of them specifically affects women, often young. How is this possible, even though the pancreas is an organ with little exposure to sex hormones? This pancreatic cancer, known ...

Scientists to improve cancer treatment effectiveness

October 19, 2018
Together with researchers from the University of Nantes and the University of Reims Champagne-Ardenne in France, experts from the National Research Nuclear University MEPhI have recently developed a quantum dot-based microarray ...

Mutant cells colonize our tissues over our lifetime

October 18, 2018
By the time we reach middle age, more than half of the oesophagus in healthy people has been taken over by cells carrying mutations in cancer genes, scientists have uncovered. By studying normal oesophagus tissue, scientists ...

Study involving hundreds of patient samples may reveal new treatment options of leukemia

October 17, 2018
After more than five years and 672 patient samples, an OHSU research team has published the largest cancer dataset of its kind for a form of leukemia. The study, "Functional Genomic Landscape of Acute Myeloid Leukemia", published ...

A 150-year-old drug might improve radiation therapy for cancer

October 17, 2018
A drug first identified 150 years ago and used as a smooth-muscle relaxant might make tumors more sensitive to radiation therapy, according to a recent study led by researchers at The Ohio State University Comprehensive Cancer ...

Loss of protein p53 helps cancer cells multiply in 'unfavourable' conditions

October 17, 2018
Researchers have discovered a novel consequence of loss of the tumour protein p53 that promotes cancer development, according to new findings in eLife.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.