Various clinical presentations of uveitis associated with durvalumab

Abstract

Background. Immune checkpoint inhibitors are becoming increasingly common in the treatment of several cancer types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80 and has recently been approved for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) and locally advanced unresectable non-small cell lung cancer (NSCLC).

Patients and methods. We report two cases of uveitides secondary to durvalumab treatment. Case 1 is a 57-year-old patient with metastatic SCLC, treated with durvalumab, who presented to our clinic for blurred vision and floaters. Eye examination revealed bilateral intermediate uveitis, bilateral optic disc oedema and visual field loss. Case 2 is a 55-year-old patient with locally advanced, unresectable NSCLC who completed immunotherapy with durvalumab three months prior to presenting to our clinic for a complaint of blurred vision. She was diagnosed with bilateral posterior uveitis.

Results. After having excluded common causes of uveitis, orbital and intracranial lesions, both patients were treated with systemic corticosteroids. This resulted in regression of floaters, regression of inflammation and, in the first case, decreased optic disc swelling.

Conclusions. There is no standardised treatment approach to the inflammatory response in the eye occurring as an adverse effect to the treatment with immune checkpoint inhibitors (ICI). Bilateral uveitis in these two cases was thought to be associated with durvalumab treatment and responded well to the systemic steroid treatment.