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Ocular Changes in Metastatic Melanoma Patients Treated with MEK Inhibitor
Cobimetinib and BRAF Inhibitor Vemurafenib
#MMPMID30018526
Gavric AU
; Ocvirk J
; Mekjavic PJ
Radiol Oncol
2018[Jun]; 52
(2
): 213-219
PMID30018526
show ga
BACKGROUND: Mitogen-activated protein kinase kinase (MEK) inhibitor cobimetinib
and V-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitor vemurafenib
have significantly improved the prognosis of BRAF-mutated metastatic melanoma.
Some ocular symptoms and signs were recently recognized to follow this treatment.
The study was aimed to investigate ocular toxicity in patients with metastatic
melanoma treated with cobimetinib in combination with vemurafenib. PATIENTS AND
METHODS: In the prospective, observational study, patients with BRAF-mutated
metastatic melanoma treated with cobimetinib in combination with vemurafenib at
the Institute of Oncology Ljubljana were asked to participate. Ophthalmic
examination was performed including measurement of visual acuity and intraocular
pressure, slit lamp examination, funduscopy (CF), infrared-reflectance (IR)
imaging and optical coherence tomography (OCT). RESULTS: Five out of 7 patients
noticed changes in vision few days after starting the therapy with cobimetinib.
In all patients, small circular lesions, described as MEKAR lesions, were
documented in outer retinal layers demonstrated with OCT, IR, and CF. Changes
were in the center and/or scattered over the retina almost symmetrical in both
eyes in 6 patients, and asymmetrical in one patient, the latter presented also
with unilateral anterior uveitis and cystoid macular edema. CONCLUSIONS: Multiple
bilateral foveal and extrafoveal small retinal lesions in the outer retinal
layers develop in patients treated with MEK inhibitor in combination with BRAF
inhibitor. Ophthalmologists and oncologists need to be aware of this common, yet
relatively benign and often transient ocular side effect to avoid needless
intervention, including the discontinuance of a potentially life-prolonging
therapy.