Targeted and Immune Therapy for Periocular and Orbital Malignancies

Abstract

The use of targeted therapy and immune checkpoint inhibitors have significantly contributed to the treatment of patients with locally advanced, unresectable metastatic periocular cancers. Sonic Hedgehog inhibitors are used to treat locally advanced or metastatic periocular basal cell carcinoma and have been found to enable a less-extensive definitive surgery. Epidermal growth factor receptor antagonists have been used to treat patients with locally advanced periocular squamous cell carcinoma with a significant reduction in tumor size and improvement in quality of life. BRAF inhibitors, with or without concurrent MEK inhibitors, have been used to treat patients with cutaneous melanoma metastatic to the orbit. Immune checkpoint inhibitors have been used to treat patients with orbital metastasis from cutaneous melanoma and patients with eyelid and conjunctival metastatic melanoma. The authors of the chapter have also observed preliminary positive response in locally advanced recurrent periocular squamous cell carcinoma treated with immune checkpoint inhibitors. These promising results for treatment of both locally advanced and metastatic periocular tumors should encourage ophthalmologists and oculoplastic surgeons to implement these treatments in appropriate cases as described in this chapter.