PDF(Pubmed)
Abstract：
Cancer-associated retinopathy (CAR) is a potentially blinding disease triggered by autoimmunity to cancer antigens at distant sites. It may masquerade as immune-related adverse events from the use of immune checkpoint inhibitors (ICIs). We present a patient with an underlying tubby-related protein 1 (TULP1) cancer-associated retinopathy who lost vision following initiation of atezolizumab for small-cell lung cancer. This 75-year-old man presented with no light perception, paramacular and peripheral retinal pigmentary changes, attenuated outer retina, and extinguished rod and cone responses. The visual loss followed the induction of atezolizumab therapy. Possible atezolizumab-associated acute macular neuroretinopathy was considered, and atezolizumab was discontinued. Vision improved on oral corticosteroid and deteriorated when corticosteroid was tapered quickly. Retinal autoantibody serology testing was negative for both anti-recoverin and anti-enolase and was positive for anti-TULP1 autoantibodies. Re-induction of atezolizumab concomitant with high-dose oral and intravitreal corticosteroids resulted in visual recovery at the three-month follow-up. These findings suggest that ICI therapy for cancer can exacerbate the retinal dysfunction in a patient with underlying autoimmunity from cancer. Patients with a high risk of CAR may need to be evaluated for retinal autoantibodies before initiation of ICI.
摘要：
癌症相关视网膜病变（CAR）是一种由远处癌症抗原自身免疫引发的潜在致盲疾病。它可能伪装成使用免疫检查点抑制剂（ICI）的免疫相关不良事件。我们介绍了一名患有潜在的输卵管相关蛋白1（TULP1）癌症相关视网膜病变的患者，该患者在开始使用阿特珠单抗治疗小细胞肺癌后视力丧失。这位75岁的老人没有光感知，眼旁和周边视网膜色素变化，减弱的外视网膜，以及熄灭的杆和锥响应。在阿特珠单抗治疗诱导后视力丧失。考虑了可能的阿妥珠单抗相关的急性黄斑神经视网膜病变，阿妥珠单抗停药.口服皮质类固醇后视力改善，皮质类固醇迅速逐渐减少时视力恶化。视网膜自身抗体血清学检测对于抗恢复素和抗烯醇化酶均为阴性，并且对于抗TULP1自身抗体为阳性。在三个月的随访中，阿特珠单抗与高剂量口服和玻璃体内皮质类固醇的再诱导导致视力恢复。这些发现表明，ICI治疗癌症可以加剧患有癌症自身免疫的患者的视网膜功能障碍。CAR高风险患者可能需要在ICI开始之前评估视网膜自身抗体。
