Immunotherapy for eye cancer

Immunotherapy helps to strengthen or restore the immune system’s ability to fight cancer. This works to kill cancer cells and stop cancer cells from growing and spreading.

Eye cancer is sometimes treated with immunotherapy. If you have immunotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules. It may be the only treatment you have or it may be used along with other treatments.

You may have immunotherapy to:

• treat some types of advanced eye cancer that have grown outside of the eyeball (called extraocular extension)
• control the symptoms of metastatic eye cancer (palliative immunotherapy)
• treat eye cancer that comes back (recurs) after treatment

Different types of immunotherapy are used for eye cancer.

Bispecific antibodies are a special type of immunotherapy that are designed to attach to 2 different targets – an immune cell and a cancer cell. These drugs bring the 2 types of cells together to help the body’s immune system attack cancer cells.

Bispecific T-cell engagers (BiTEs) are a type of bispecific antibody used to treat eye cancer. They work by attaching to the CD3 protein on T cells and to a specific protein on the cancer cells, such as glycoprotein 100 (gp100).

Tebentafusp-tebn (Kimmtrak) can be used to treat metastatic or advanced uveal melanoma that produces human leukocyte antigen (HLA)-A*02:01. It is usually the first-line therapy for this cancer. This BiTE is typically given through a needle into a vein (intravenous) once a week.

Bispecific antibodies may not be available in all areas or covered by all provincial and territorial health plans.

The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints. Checkpoints slow down or stop an immune system response. Some eye cancer cells sometimes use these checkpoints to hide and avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so T cells can attack and kill the cancer cells.

Immune checkpoint inhibitors are monoclonal antibodies that work by blocking checkpoint proteins so that immune system cells can attack and kill the cancer cells.

These immune checkpoint inhibitors may be used to treat metastatic or advanced uveal melanoma that can’t be treated with surgery:

Pembrolizumab (Keytruda) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. It is usually given on its own. Pembrolizumab is usually given through a needle into a vein (intravenous, or IV) once every 3 to 6 weeks.

Nivolumab (Opdivo) is an immune checkpoint inhibitor that targets the PD-1 checkpoint protein. Nivolumab is often given with ipilimumab, but it may also be given on its own. It is usually given by IV every 2 to 4 weeks.

Ipilimumab (Yervoy) is an immune checkpoint inhibitor that targets the CTLA-4 checkpoint protein. Ipilimumab is typically given with nivolumab, but it can be given on its own in some cases. It is usually given by IV once every 3 weeks.

The following immune checkpoint inhibitor may be used instead of orbital exenteration when squamous cell carcinoma (SCC) of the conjunctiva can’t be removed with surgical excision.

Cemiplimab (Libtayo) is an immune checkpoint inhibitor that also targets the PD-1 checkpoint protein. It is usually given by IV once every 2 to 3 weeks.

Cytokines are proteins made by the immune system. They can also be made in a lab and given as a drug. Cytokines act as chemical messengers so the immune system cells communicate with each other and help control the immune response. Cytokines stimulate the immune system to attack cancer cells.

Interferon alfa-2b (INF2b) is a cytokine that controls cancer growth. It may be given as eye drops for lymphoma of the conjunctiva or SCC of the conjunctiva.

Side effects of immunotherapy will depend mainly on the type of eye cancer you have, the type of drug or drug combination, the dose and your overall health. Tell your healthcare team if you have side effects that you think might be from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

These are common side effects of immunotherapy for eye cancer:

• fever
• nausea and loss of appetite
• skin problems, including redness and itching
• fatigue
• redness and swelling at injection site
• shortness of breath (dyspnea)
• diarrhea
• constipation
• pain, including in your muscles, joints, stomach and back
• liver problems, including changes to levels of liver enzymes

Treatment with tebentafusp-tebn can also cause cytokine release syndrome, edema and low blood pressure (hypotension).

Find out more about immunotherapy and side effects of immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.