Intravenous rituximab and oral cyclophosphamide for the treatment of cancer‑associated retinopathy in a patient with epithelial ovarian cancer: A case report

Andrikopoulou,Angeliki; Koutsoukos,Konstantinos; Chatziralli,Irini; Theodossiadis,Panagiotis; Tsivgoulis,Georgios; Tzartos,John; Anastasakis,Anastasios; Zagouri,Flora; Dimopoulos,Meletios-Athanasios

doi:10.3892/ol.2023.13894

Intravenous rituximab and oral cyclophosphamide for the treatment of cancer‑associated retinopathy in a patient with epithelial ovarian cancer: A case report

Authors:
- Angeliki Andrikopoulou
- Konstantinos Koutsoukos
- Irini Chatziralli
- Panagiotis Theodossiadis
- Georgios Tsivgoulis
- John Tzartos
- Anastasios Anastasakis
- Flora Zagouri
- Meletios-Athanasios Dimopoulos
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Affiliations: Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece, Second Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece, Second Department of Ophthalmology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece, Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece, Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece, Department of Clinical Electrophysiology of Vision, Athens Eye Hospital, 16675 Athens, Greece
Published online on: June 1, 2023 https://doi.org/10.3892/ol.2023.13894
Article Number: 308

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Abstract

Cancer‑associated retinopathy (CAR) is a rare paraneoplastic disorder mediated by auto‑antibodies that cross‑react with retinal antigens leading to gradual visual defects. Early diagnosis and initiation of treatment is crucial to avoid permanent visual loss. Although most patients with CAR respond to intravenous steroids and intravenous immunoglobulin (IVIG), there are some cases refractory to the aforementioned treatment strategies. The present study describes a case of CAR in a patient with ovarian cancer that was initially resistant to most treatment regimens (chemotherapy, steroids, IVIG). Treatment with rituximab at 375 mg/m² and oral cyclophosphamide was administered and the patient showed marked improvement of visual acuity. Electroretinogram showed a 40 and 10% improvement in scotopic and photopic vision, respectively. Notably, at the most recent follow up, the patient was still in remission. In conclusion, treatment with intravenous rituximab and oral cyclophosphamide is a promising treatment option for those cases of CAR that do not respond to steroids, immunomodulatory agents and IVIG.

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