Ocular Adverse Events of Antibody Drug Conjugates and Association With Survival From a Real-World Database

Purpose: Ocular adverse events can be black box warning complications for antibody drug conjugates (ADCs), requiring ophthalmologic evaluation. Although extensive management and deescalation protocols are in place, association with overall survival for patients with ocular adverse events are unknown. Methods: Retrospective cohort study with data from deidentified aggregated electronic health records database. Inclusion criteria were prescription of ADCs, no prior recorded ocular symptoms, and the presence of a clinical visit after ADC initiation. Propensity score matching was used to control for demographic factors and cancer diagnoses. Results: A cohort of 14,138 patients with a mean age of 59 years (SD: 20y) was identified. Most common ocular adverse events were dry eyes (2.9%), keratitis or conjunctivitis (2.21%), uveitis (0.23%), and corneal ulcers (0.085%). Belantamab mafodotin had the highest rates of keratitis or conjunctivitis (17.8%). Patients without any ocular adverse events after ADC initiation had an increased risk of death [RR: 1.20, P = 0.0013] within 5 years compared with patients with ocular adverse events. Specifically, patients without keratitis or conjunctivitis after ADC initiation had an increased risk of death [RR: 1.43, P = 0.019] within 1 year. Conclusions: Uveitis and corneal ulcers were exceedingly rare for all ADCs. Patients on ADCs with ocular adverse events, compared with those without, had a decreased risk of death. 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.