Ocular adverse events associated with antibody drug conjugates (ADCs) are associated with improved survival outcomes in patients with cancer, according to research published in Cornea. The findings suggest these complications may serve as a marker of treatment response.
“ADCs are a novel oncological drug class that combine cytotoxic payloads with a monoclonal antibody that target antigens expressed on the surface of malignant cells. This novel design increases targeted delivery of cytotoxic payloads to cancer cells, limiting systemic side effects, and increasing medication efficacy,” according to the study authors. “Nonetheless, many of these ADCs have associated ocular toxicities, leading to treatment deescalation, delays, or permanent discontinuation with severe ocular adverse events.”
The investigators conducted a retrospective cohort study to evaluate the incidence of ocular adverse events in patients on ADCs and to determine if the development of ocular adverse events predicts differences in survival.
The research team used data from a deidentified aggregated electronic health records database, representing 160 million patients both within the United States and globally, up to February 6, 2025. Patients with prescription of ADCs, no prior recorded ocular symptoms, and the presence of a clinical visit after ADC initiation were included in the study. Statistical matching was used to control for demographic factors and cancer diagnoses.
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Patients on ADCs with ocular adverse events, compared with those without, had a decreased risk of death.
The analysis included 14,138 patients (mean age, 59 years; 50.8% men), who had at least 1 year of follow up and no prior history of ophthalmic disease before ADC initiation. The most common cancer diagnoses in the cohort were non-Hodgkin lymphoma (38%), Hodgkin lymphoma (25%), non-follicular lymphoma (24%), malignant neoplasm of breast (13%), and malignant neoplasm of urinary tract (11%).
The most common ocular adverse events were dry eye (2.9%), keratitis or conjunctivitis (2.21%), uveitis (0.23%), and corneal ulcers (0.085%). Belantamab mafodotin was associated with the highest rate of keratitis or conjunctivitis (17.8%).
Patients who did not experience ocular adverse events after ADC initiation had a higher risk of death within 5 years compared with those who did (relative risk [RR], 1.20; P =.0013). In particular, absence of keratitis or conjunctivitis was associated with increased 1-year mortality risk (RR, 1.43; P =.019).
“Patients on ADCs with ocular adverse events, compared with those without, had a decreased risk of death,” according to the study authors. “As ophthalmologic management of patients on ADCs are becoming more prevalent, aggressive management of ocular adverse events may be warranted, when ADCs are effective, as ocular adverse events may portend better survival outcomes.”
The primary limitation of the study was the retrospective cohort design.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Optometry Advisor
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