Uveitis Associated with Protein Kinase Inhibitors in Cancer Patients: A Risk-Based Ophthalmologic Management

To review the available literature on uveitis associated with protein kinase inhibitors (PKIs) in oncologic patients, with the aim of summarizing clinical presentations and therapeutic strategies and proposing a risk-adapted framework for ophthalmologic monitoring and management. All FDA-approved PKIs were identified using the National Cancer Institute's targeted therapy database. A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was conducted for each agent using standardized keywords related to uveitis and oncology. Eligible sources included case reports, case series, and observational studies describing PKI-associated uveitis. Clinical data were extracted and analyzed, focusing on uveitis subtype, time of onset, treatment modalities, and visual outcomes. Uveitis has been reported in association with 18 of the 71 FDA-approved PKIs, with vemurafenib emerging as the most frequently reported agent. The most common route of administration for PKIs is oral. Onset ranged from a few days to over 12 months following treatment initiation. The most frequently observed phenotype was anterior uveitis, followed by panuveitis, posterior, and intermediate forms. Treatment typically involved topical, oral, or intravitreal corticosteroids, often combined with temporary or permanent discontinuation of the PKI. Drawing from therapeutic approaches described in the literature and associated outcomes, we proposed initial treatment recommendations tailored to the specific uveitis subtype. Although uncommon, PKI-associated uveitis can cause significant visual morbidity if unrecognized. Early diagnosis and interdisciplinary management are essential. A risk-adapted surveillance protocol and subtype-specific therapeutic recommendations may improve visual outcomes and support the continuation of oncologic therapy.