Bilateral lacrimal gland enlargement secondary to immune checkpoint inhibitors; pembrolizumab, ipilimumab and nivolumab
Author: Matthew Fenech
Base Hospital / Institution: Aintree University Hospital
ePoster presentation
Abstract ID: 24-219
Purpose
Immune checkpoint inhibitors (ICPi) work through numerous pathways, including the anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), anti PD-1 (programmed cell death protein 1) and the PD-L1 (protein cell death protein-ligand-1) pathways. They are proving to be an exciting therapeutic avenue in the attempt to activate anti-tumour activity. Ipilimumab is a fully human monoclonal antibody working on the anti-CTLA-4 pathway while pembrolizumab and nivolumab, an immunoglobulin G4 (IgG4), inhibit the PD-1 pathway. We present two cases treated with ICPi inhibitors subsequently developing bilateral lacrimal gland enlargement.
Methods
Case 1: 69-year old male patient with recurrent multifocal sino-nasal melanoma. Initially treated with a total rhinectomy and sinusectomy, partial palate removal, partial cheek removal and post-operative radiotherapy. Repeat (PET) scan revealed prominent nodes. Ipilimumab and nivolumab were initiated. The patient developed visual snow and bilateral lacrimal gland swelling on treatment.
Case 2: 45 year old female patient. Pembrolizumab initiated for the management of breast cancer. 2 weeks after starting treatment, bilateral lacrimal gland prolapse and enlargement was noted. Lacrimal gland biopsy revealed chronic inflammation with no evidence of metastasis.
Results
Case 1: Follow-up 6 months after presentation revealed complete resolution of the lacrimal gland prolapse along with resolution of the visual snow, coinciding with the cessation of ICPi therapy.
Case 2: Oral steroids and cessation of immune-checkpoint inhibitor therapy resulted in complete resolution of lacrimal gland enlargement
Conclusion
Whilst a growing body of research is continually being made available for these novel therapies, early indications show that they are limited by their greater efficacy in cancers with high a mutational burden and their side effect profile, primarily autoimmune manifestations and symptoms. We provide further insight into the side effect profile and toxicity of these immunomodulatory agents which are increasingly being used in day to day practice.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ayodeji | Ajanaku | Aintree University Hospital |
| Austin | McCormick | Aintree University Hospital |
| Nima | Ghadiri | Aintree University Hospital |
