Corneal Findings in Novel Cancer Drug Class

by Dr. Asim Farooq

Reporting ophthalmologic findings associated with a new drug class for refractory cancer

Dr. Asim Farooq is warning all eye care professionals of new corneal findings associated with a new class of drug for refractory cancer: antibody-drug conjugates (ADCs). This type of drug specifically targets and attaches to cancer cells, releasing a cytotoxic payload that induces apoptosis. With over 200 clinical trials in the works, this new type of drug may represent a paradigm shift in cancer treatment and is likely to land in the chairs of eye care providers in referral or even routine settings. It is important for eye doctors to understand the mechanism and see a representative case so that they can manage their patients accordingly.

Key Summary Points of the Article

  • Corneal microcyst-like epithelial changes (MECs) are frequently associated with antibody–drug conjugates (ADCs) containing monomethyl auristatin F, which have been studied in a variety of cancers, including belantamab mafodotin (belamaf, GSK2857916) currently being investigated for the treatment of relapsed or refractory multiple myeloma.
  • In this report, the authors further characterize belamaf-associated MECs and provide a representative case report. MECs typically are seen early in treatment, are manageable with dose modifications, and tend to resolve after completing treatment.
  • Presented images demonstrate that MECs appear as bilateral, diffuse, microcyst-like lesions on slit lamp photography; however, on confocal microscopy the affected areas appear as hyperreflective material that is (at least predominantly) intracellular.
  • Available literature on corneal events with other ADCs supports the observations with belamaf treatment and confirms the need for additional research on the underlying pathophysiology and optimal management.
  • The authors propose a mechanism whereby MECs represent an off-target effect of belamaf in the cornea leading to apoptosis of epithelial cells, which are eventually replaced with new epithelial cells, leading to the eventual resolution of MECs and symptoms after completing treatment.

Read the full article here

Reference: Farooq, A.V., Degli Esposti, S., Popat, R. et al. Corneal Epithelial Findings in Patients with Multiple Myeloma Treated with Antibody–Drug Conjugate Belantamab Mafodotin in the Pivotal, Randomized, DREAMM-2 Study. Ophthalmol Ther (2020).

Asim Farooq, MD

Associate Professor of Ophthalmology and Visual Science

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