First Author: D.Sousa PORTUGAL
Co Author(s): I. Leal R. Sousa F. Pinto
Back to previous
Mitogen-activated protein kinase inhibitors (MEK-i) have aroused considerable interest in oncology, showing efficacy in several types of malignancies, especially melanoma. Currently, only sparse data are available on retinal safety profile of MEK-i. We aim to report and analyze the ophthalmic features and follow-up of a series of patients diagnosed with melanoma and treated with MEK-i.
Ophthalmology Dept., Hospital de Santa Maria, Lisboa, PT.
Interventional case-series. Patients with advanced cutaneous melanoma about to start treatment with a MEK-i as single therapy or together with a v-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitor were referred to the ophthalmology department and included consecutively. All patients underwent a baseline ophthalmologic examination, including visual acuity, intraocular pressure, biomicroscopy, fundoscopy, and optical coherence tomography (OCT) and were followed-up at regular intervals or as needed.
Five patients (3 male), with a mean age of 57 ± 14 years were included. Past ophthalmological history was unremarkable. Ocular adverse events appeared in 2/5 patients at least after 2 weeks of treatment onset. In these patients, OCT revealed a subfoveal serous neuroretinal detachment (SRF), asymptomatic in all but one patient, which spontaneously resolved after a mean of 5.5 ± 2.1 weeks with no MEK-i withdrawal or dose reduction. In those presenting with SRF, right and left eye mean central macular thickness at baseline increased from 290 ± 8.5 μm and 287 ± 3.5 μm to 342 ± 26 μm and 335 ± 35 μm, respectively (p>0.05). Although not significant (p>0.05), last follow-up right and left eye central mean macular thickness was inferior than baseline values, i.e. 287 ± 4 μm and 282 ± 3 μm, respectively. No other complications were noted and the association with a BRAF inhibitor did not seem predictive of SRF occurrence.
A reversible and sometimes fluctuant serous retinopathy can develop in patients treated with MEK-i for metastatic melanoma. A minority of patients develops SFR, which are generally mild and transient. The cause of MEK-i-associated serous retinopathy remains uncertain and deserves better characterization to improve visual functional outcomes in these patients.