Abstract Details

Title Successful Treatment of Immune Checkpoint Inhibitor Induced Optic Neuritis

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 14-004

Background Although there has been increasing use of ICI therapies due to their efficacy and lower toxicity in comparison to other immunotherapies, there has also been a surge of ICI-related neurological adverse effects. Treatment protocols for ICI-related neurologic complications are minimal and typically have poor outcomes. Pembrolizumab is a PD-1 receptor inhibitor that has been associated with neuro-ophthalmological complications including myasthenia gravis and bilateral optic neuritis.

Objective To describe plasma exchange (PLEX) as a successful treatment option for a case of optic neuritis secondary to immune checkpoint inhibitor (ICI) therapy.

Design/Methods Descriptive study

Results A 53-year-old female with left vulvar carcinoma resistant to treatment with radiation and triple chemotherapy with Carboplatin/Paclitaxel/Bevacizumab was transitioned to Pembrolizumab. She had received a total of 9 doses of Pembrolizumab when she developed bilateral eye pain and blurry vision. MRI of the brain and orbits was positive for enhancement of the bilateral optic discs and retro-bulbar portion of the right optic nerve concerning for bilateral optic neuritis. Cerebrospinal fluid analysis at this time was non-diagnostic with normal cells and protein. She was treated with two rounds of high dose steroids including Dexamethasone (4 days taper) and 1000 mg solumedrol for 5 days, respectively, with no clinical benefit. Given significant impairment in vision (20/200 OD, HM+ OS), she was treated with PLEX for five sessions. Following PLEX, there was significant improvement in her vision with return of visual acuity to 20/20(OD) and 20/25(OS) and stable vision during ophthalmology clinic visit two weeks later.

Conclusions Recommendations for the treatment of ICI-related optic neuritis includes the use of high-dose pulse steroids and prolonged oral taper, although visual prognosis remains poor. Our case study provides evidence for a tremendous recovery with PLEX for pembrolizumab-associated optic neuritis. Aggressive acute initial management of ICI-related complications should be considered, especially in cases of increased morbidity and mortality.

Authors/Disclosures
Jessica Frey, MD (West Virginia University) PRESENTER	The institution of Dr. Frey has received research support from Tourette Association of America.
Supriya Ramesha, MBBS (West Virginia University)	Dr. Ramesha has nothing to disclose.