Axitinib tablets combined with toripalimab injection in the treatment of renal cancer-induced central retinal artery occlusion: a case report

doi:10.19803/j.1672-8629.20220552

Abstract

Abstract: Objective To analyze the clinical characteristics, diagnosis and treatment of central retinal artery occlusion caused by axitinib combined with toripalimab in the treatment of advanced renal cell carcinoma. Methods One case of central retinal artery occlusion caused by advanced renal cell carcinoma treated with axitinib combined with toripalimab was analyzed. Results A patient with advanced renal cell carcinoma received axitinib 5 mg combined with toripalimab 240 mg, intravenous drip, once every two weeks. The overall survival (OS) was more than 5 years, and the progression-free survival (PFS) was nearly 4 years, suggesting the significant efficacy of this therapy. After 2.5 years of combined treatment, central retinal artery occlusion occurred in the right eye. No thrombosis was found by cranial enhanced MRI, chest enhanced CT or by color Doppler ultrasound of carotid and cranial vessels, lower limb arteries and veins, and renal vessels. D-dimer was 0.5 mg·L^-1 (within the normal range) and ophthalmic examinations were performed to rule out other eye diseases. Toripalimab might increase the risk of thromboembolism, which was suspected of aggravating the adverse reactions of axitinib. Axitinib was discontinued, eye massage was adopted, timolol eye drops were given to reduce intraocular pressure. Lidocaine, caceanisodamine hydrochloride and dexamethasone sodium phosphate were injected retrobulbarly to alleviate spasm. Urokinase was used for thrombolysis. Methylprednisolone sodium succinate 30 mg·d^-1 was given intravenously. However, these medications failed to improve the visual acuity of the right eye, but no other ocular symptoms were found during the follow-up. Conclusion Axitinib combined with toripalimab is effective for advanced renal cell carcinoma. The combined treatment requires that the clinical symptoms and imaging characteristics of patients be monitored, and clinicians should be alert to the risk of central retinal artery occlusion.

Key words: axitinib, toripalimab, renal cancer, central retinal artery occlusion, combinations, adverse drug reactions

CLC Number:

WANG Shuwei, YIN Jinjun, WANG Bing, SONG Caiping, YANG Fujun. Axitinib tablets combined with toripalimab injection in the treatment of renal cancer-induced central retinal artery occlusion: a case report[J]. Chinese Journal of Pharmacovigilance, 2023, 20(7): 825-828.

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