Skip to main content
Top
Published in: BMC Cancer 1/2013

Open Access 01-12-2013 | Case report

Severe pan-uveitis in a patient treated with vemurafenib for metastatic melanoma

Authors: Sanne EJ Wolf, Christina Meenken, Annette C Moll, John B Haanen, Michiel S van der Heijden

Published in: BMC Cancer | Issue 1/2013

Login to get access

Abstract

Background

Vemurafenib, an inhibitor of genetically activated BRAF, is now commonly prescribed for metastatic melanoma harboring a BRAF mutation. Reports on side effects have focused on cutaneous complications. We here present a case of a severe pan-uveitis associated with vemurafenib use.

Case presentation

A 63-year old female was treated with the BRAF inhibitor vemurafenib for metastatic melanoma. After seven weeks of treatment, she developed near-complete visual loss in the course of a few days, as a result of severe uveitis. Vemurafenib had to be discontinued and systemic and topical corticosteroids were initiated. The visual symptoms improved slowly, however the cerebral metastases progressed and the patient died from her disease.

Conclusion

Treatment with vemurafenib has become an important component of standard clinical care for patients with metastatic melanoma. In addition, it is one of the best examples of genotype-directed therapy. This case illustrates that vemurafenib-induced uveitis can develop fast and be slow to resolve. Awareness of this potentially severe side effect is of major importance to oncologists and aggressive treatment should be considered.
Appendix
Available only for authorised users
Literature
1.
go back to reference Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J, Dummer R, Garbe C, Testori A, Maio M, et al: Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011, 364 (26): 2507-2516. 10.1056/NEJMoa1103782.CrossRefPubMedPubMedCentral Chapman PB, Hauschild A, Robert C, Haanen JB, Ascierto P, Larkin J, Dummer R, Garbe C, Testori A, Maio M, et al: Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med. 2011, 364 (26): 2507-2516. 10.1056/NEJMoa1103782.CrossRefPubMedPubMedCentral
2.
go back to reference Hauschild A, Grob JJ, Demidov LV, Jouary T, Gutzmer R, Millward M, Rutkowski P, Blank CU, Miller WH, Kaempgen E, et al: Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2012, 380 (9839): 358-365. 10.1016/S0140-6736(12)60868-X.CrossRefPubMed Hauschild A, Grob JJ, Demidov LV, Jouary T, Gutzmer R, Millward M, Rutkowski P, Blank CU, Miller WH, Kaempgen E, et al: Dabrafenib in BRAF-mutated metastatic melanoma: a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2012, 380 (9839): 358-365. 10.1016/S0140-6736(12)60868-X.CrossRefPubMed
3.
go back to reference Robert C, Thomas L, Bondarenko I, O'Day S, DJ M, Garbe C, Lebbe C, Baurain JF, Testori A, Grob JJ, et al: Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011, 364 (26): 2517-2526. 10.1056/NEJMoa1104621.CrossRefPubMed Robert C, Thomas L, Bondarenko I, O'Day S, DJ M, Garbe C, Lebbe C, Baurain JF, Testori A, Grob JJ, et al: Ipilimumab plus dacarbazine for previously untreated metastatic melanoma. N Engl J Med. 2011, 364 (26): 2517-2526. 10.1056/NEJMoa1104621.CrossRefPubMed
4.
go back to reference Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, et al: Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010, 363 (8): 711-723. 10.1056/NEJMoa1003466.CrossRefPubMedPubMedCentral Hodi FS, O'Day SJ, McDermott DF, Weber RW, Sosman JA, Haanen JB, Gonzalez R, Robert C, Schadendorf D, Hassel JC, et al: Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010, 363 (8): 711-723. 10.1056/NEJMoa1003466.CrossRefPubMedPubMedCentral
5.
go back to reference Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, Hamid O, Schuchter L, Cebon J, Ibrahim N, et al: Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012, 367 (18): 1694-1703. 10.1056/NEJMoa1210093.CrossRefPubMedPubMedCentral Flaherty KT, Infante JR, Daud A, Gonzalez R, Kefford RF, Sosman J, Hamid O, Schuchter L, Cebon J, Ibrahim N, et al: Combined BRAF and MEK inhibition in melanoma with BRAF V600 mutations. N Engl J Med. 2012, 367 (18): 1694-1703. 10.1056/NEJMoa1210093.CrossRefPubMedPubMedCentral
6.
go back to reference Topalian SL, Hodi FS, Brahmer JR, Gettinger SN, Smith DC, McDermott DF, Powderly JD, Carvajal RD, Sosman JA, Atkins MB, et al: Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012, 366 (26): 2443-2454. 10.1056/NEJMoa1200690.CrossRefPubMedPubMedCentral Topalian SL, Hodi FS, Brahmer JR, Gettinger SN, Smith DC, McDermott DF, Powderly JD, Carvajal RD, Sosman JA, Atkins MB, et al: Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012, 366 (26): 2443-2454. 10.1056/NEJMoa1200690.CrossRefPubMedPubMedCentral
7.
go back to reference Di Giacomo AM, Biagioli M, Maio M: The emerging toxicity profiles of anti-CTLA-4 antibodies across clinical indications. Semin Oncol. 2010, 37 (5): 499-507. 10.1053/j.seminoncol.2010.09.007.CrossRefPubMed Di Giacomo AM, Biagioli M, Maio M: The emerging toxicity profiles of anti-CTLA-4 antibodies across clinical indications. Semin Oncol. 2010, 37 (5): 499-507. 10.1053/j.seminoncol.2010.09.007.CrossRefPubMed
8.
go back to reference Sandhu S, Ling C, Lim L, Zamir E, Stawell R: Vemurafenib (B-RAF inhibitor) associated uveitis in patients with metastatic cutaneous melanoma. Clin Exp Ophth. 2012, 40 (S1): 118- Sandhu S, Ling C, Lim L, Zamir E, Stawell R: Vemurafenib (B-RAF inhibitor) associated uveitis in patients with metastatic cutaneous melanoma. Clin Exp Ophth. 2012, 40 (S1): 118-
9.
go back to reference Fraunfelder FW, Rosenbaum JT: Drug-induced uveitis. Incidence, prevention and treatment. Drug Saf. 1997, 17 (3): 197-207. 10.2165/00002018-199717030-00005.CrossRefPubMed Fraunfelder FW, Rosenbaum JT: Drug-induced uveitis. Incidence, prevention and treatment. Drug Saf. 1997, 17 (3): 197-207. 10.2165/00002018-199717030-00005.CrossRefPubMed
11.
go back to reference Gueudry J, LeHoang P, Bodaghi B: Anti-tumor necrosis factor-alpha agents in noninfectious uveitis. Dev Ophthalmol. 2012, 51: 63-78.CrossRefPubMed Gueudry J, LeHoang P, Bodaghi B: Anti-tumor necrosis factor-alpha agents in noninfectious uveitis. Dev Ophthalmol. 2012, 51: 63-78.CrossRefPubMed
12.
go back to reference Markomichelakis N, Delicha E, Masselos S, Fragiadaki K, Kaklamanis P, Sfikakis PP: A single infliximab infusion vs corticosteroids for acute panuveitis attacks in Behcet's disease: a comparative 4-week study. Rheumatology (Oxford). 2011, 50 (3): 593-597. 10.1093/rheumatology/keq366.CrossRef Markomichelakis N, Delicha E, Masselos S, Fragiadaki K, Kaklamanis P, Sfikakis PP: A single infliximab infusion vs corticosteroids for acute panuveitis attacks in Behcet's disease: a comparative 4-week study. Rheumatology (Oxford). 2011, 50 (3): 593-597. 10.1093/rheumatology/keq366.CrossRef
13.
go back to reference Boyd KP, Vincent B, Andea A, Conry RM, Hughey LC: Nonmalignant cutaneous findings associated with vemurafenib use in patients with metastatic melanoma. J Am Acad Dermatol. 2012, 67 (6): 1375-1379. 10.1016/j.jaad.2012.06.045.CrossRefPubMed Boyd KP, Vincent B, Andea A, Conry RM, Hughey LC: Nonmalignant cutaneous findings associated with vemurafenib use in patients with metastatic melanoma. J Am Acad Dermatol. 2012, 67 (6): 1375-1379. 10.1016/j.jaad.2012.06.045.CrossRefPubMed
Metadata
Title
Severe pan-uveitis in a patient treated with vemurafenib for metastatic melanoma
Authors
Sanne EJ Wolf
Christina Meenken
Annette C Moll
John B Haanen
Michiel S van der Heijden
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2013
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-13-561

Other articles of this Issue 1/2013

BMC Cancer 1/2013 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine