Epiphora and Eye Symptoms from Adjuvant Docetaxel-Based Regimens for Early Breast Cancer: An Interim Analysis.
Authors: Chan A. , De Boer R. , Su C. , Gajdatsy A. , Provis A. , Osmond F. , Whyte A. 
Published: December 2010

Background: Many women receiving adjuvant chemotherapy for early breast cancer (EBC) report a variety of ocular symptoms. Epiphora has been reported in up to 26% of women receiving 5-fluorouracil-based chemotherapy and in patients (pts) receiving docetaxel in the metastatic setting; with lacrimal duct obstruction being a potential cause. The incidence, severity and duration of epiphora in pts receiving docetaxel-based chemotherapy in the adjuvant setting is unknown.Methods: Commencing in 12/07, 100 consecutive pts without pre-existing epiphora who receive adjuvant docetaxel -based chemotherapy regimens at 2 cancer centres for EBC will be included. All pts receive standard chemotherapy doses and dexamethasone pre-medication as appropriate for the regimen. Pts will have three ophthalmological assessments by a single ophthalmologist per centre: prior to cycle 1 (C1), mid-way through regimen (interim) and 3m post completion. A CT-Dacryocystogram (CT-DCG) will be performed at baseline and 3 months after completion of chemotherapy. At each chemotherapy visit pts will complete an eye symptom questionnaire, FACT-Taxane, and incidence and severity of eye symptoms will be recorded.Results: We have currently recruited 81 pts (mean age 52y (range 32-76), 41 (51%) premenopausal, 40 (49%) postmenopausal; 72 patients having completed chemotherapy, 51 have undergone second CT_DCG. Chemotherapy given was TAC (46), TCH (16), TC (12), FEC-T (7). At baseline, asymptomatic lacrimal duct obstruction on CT-DCG and duct irrigation was seen in 17 (21%) and 15 (19%) pts, respectively. Of 51 pts who have had post-chemotherapy assessment, 17 (33%) and 13 (25%) had degree of obstruction on CT-DCG and irrigation, respectively. Incidence of several eye symptoms is shown below.Incidence of eye symptoms After cycle 1 n=82Interim n=75Last cycle n=71Follow-up n=56Epiphora19.5%65.3%70.4%8.9%Altered eye sensation2.4%18.7%21.1% Blepharospasm 2.7%4.2% Blurring3.7%21.3%22.5%7.1%Dry eyes 8%8.5%3.6%Eye irritation 4%7%3.6%Gritty eyes 1.3%1.4% Itchy eyes12.2%21.3%22.5%7.1%Photophobia 1.3%1.4% Red eyes1.2%1.3%1.4% Sticky eyes 5.3%9.9% Stinging4.9%6.7%9.9%7.1% Patient reported interference with driving, reading and other visual tasks occurred from 2-12% pts after C1, increased to 25-76% at last cycle but decreased to 9-11% by 3m after chemotherapy.Conclusions: This is the first prospective study evaluating incidence of epiphora and other eye symptoms secondary to adjuvant docetaxel-based chemotherapy. A significant proportion of asymptomatic pts had objective lacrimal duct pathology prior to treatment. Incidence of all eye symptoms increased promptly following commencement of chemotherapy and impacted on visual tasks in an increasingly higher proportion of pts over time. At 3 months review, incidence of eye symptoms was reduced despite a higher rate of objective duct pathology than at baseline. Further studies are needed to identify the drug(s) and mechanism by which eye symptoms are caused; with focus on prophylactic interventions.This study was supported by a study grant from Sanofi-Aventis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1119.