Supplementary Material for: Sight-threatening immune retinopathy developing secondary to durvalumab treatment of small-cell lung cancer: A case report

Introcution: Given the recent additions of immune checkpoint inhibitors (ICIs) to various cancer treatments, adverse effects, especially involving the eyes, have been on the rise. Here, we report an acute exacerbation of cancer-associated retinopathy (CAR) triggered by durvalumab treatment of small-cell lung cancer (SCLC).
Case presentation: A 81-year-old Asian male complained of a scotoma in the left eye after durvalumab administration, to treat small-cell lung cancer (SCLC). Humphrey visual field examination revealed a C-shaped temporal scotoma. Spectralis domain optical coherence tomography (SD-OCT) revealed outer retinal layer atrophy and progressive loss of the ellipsoid zone in the atrophic peripapillary area. Fundus autofluorescence (AF) images evidenced a large C-shaped hypoautofluorescence with enhanced AF at the margin of the atrophic area, thus at the position of the scotoma. We prescribed subtenon triamcinolone injections under suspicion of CAR exacerbation, supported by positive Western blotting results for Rab6 and aldolase, and immunohistochemical staining of photoreceptor cells. The disrupted ellipsoid zone evident on OCT partially recovered and a visual field test showed that the scotoma had improved.
Conclusion: ICI-triggered exacerbation of CAR should be considered in SCLC patients before ICI treatment commences; an optimal treatment should preserve functional vision.