Neuro-ophthalmic complications of modern anti-cancer drugs

Purpose Targeted cancer therapies have been responsible for a dramatic shift in treatment strategies for cancer, and the number of drugs, classes, and indications are continually growing. Neuro-ophthalmic complications of these medications are an uncommon but important subset of adverse events which...

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Bibliographic Details
Published in:	Graefe's archive for clinical and experimental ophthalmology Vol. 262; no. 7; pp. 2269 - 2281
Main Authors:	Oskam, Joshua A., Danesh-Meyer, Helen V.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2024 Springer Nature B.V
Subjects:	Adverse events Antineoplastic Agents - adverse effects Antineoplastic drugs Cancer Cancer therapies Drug delivery Drugs Eye diseases Eye Diseases - chemically induced Eye Diseases - diagnosis Food webs Humans Immune checkpoint inhibitors Immunosuppressive agents Ischemia Leukoencephalopathy Medicine Medicine & Public Health Myasthenia gravis Neoplasms - drug therapy Neuritis Neuromuscular junctions Neurophthalmology Ophthalmology Optic nerve Optic neuritis Optic neuropathy Proteasomes Vascular endothelial growth factor Vision Withdrawal Complications Neuro-ophthalmology Targeted cancer therapy
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Summary:	Purpose Targeted cancer therapies have been responsible for a dramatic shift in treatment strategies for cancer, and the number of drugs, classes, and indications are continually growing. Neuro-ophthalmic complications of these medications are an uncommon but important subset of adverse events which profoundly impact vision. This review aims to collate studies and reports of known neuro-ophthalmic complications of targeted therapies and describe their management. Methods The anti-cancer drugs included in the review were any drugs targeting specific molecules involved in the cancer disease process. PubMed, EMBASE, and Web of Science were searched using the generic names of each drug and keywords of neuro-ophthalmic conditions. The prescribing information published by the US Food and Drug Administration (FDA) for each drug was also reviewed. Results Several classes of targeted anti-cancer drugs were found to cause neuro-ophthalmic adverse effects. Immune checkpoint inhibitors are responsible for a raft of immune-related adverse events such as optic neuritis, ischemic optic neuropathy, PRES, and myasthenia gravis. Therapies with anti-VEGF activity can provoke posterior reversible leukoencephalopathy, which commonly presents with visual loss and can be fatal if not treated promptly. Inhibitors of BCR-ABL1, VEGF, ALK, and proteasomes have all been linked to optic nerve disorders which can have debilitating consequences for vision. Conclusion The neuro-ophthalmic complications of modern anti-cancer drugs can limit or necessitate the withdrawal of these life-prolonging medications. Ophthalmologists should be alert for neuro-ophthalmic complications in these medications to facilitate prompt diagnosis and treatment and reduce the risk of severe and permanent consequences.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	0721-832X 1435-702X 1435-702X
DOI:	10.1007/s00417-023-06350-4