Lacrimal drainage system stenosis associated with Trastuzumab emtansine (Kadcyla®, T-DM1) administration: a case report

Abstract

Background Trastuzumab emtansine (Kadcyla®, T-DM1) is an antibody-drug conjugate used to treat HER2 (human epidermal growth factor receptor 2) overexpressing metastatic breast cancer. In this report, we present the first case of lacrimal drainage system stenosis identified after T-DM1 administration, and its successful treatment with a topical steroid. Case presentation A 36-year-old female with metastatic breast cancer was referred for excessive tearing of both eyes. She previously underwent mastectomy and was treated with multiple anti-cancer regimens. However, metastases to liver and bone were identified and T-DM1 was administered. After 2 months, epiphora developed in both eyes and the patient was referred for ophthalmologic examination. The height of the tear meniscus was increased. The fluorescein dye disappearance test (FDDT) showed a delayed clearance in both eyes. Diagnostic lacrimal probing demonstrated a lower distal canalicular stenosis in both eyes. Dacryocystography indicated multiple focal narrowing of nasolacrimal duct in the right eye and diffused narrowing of nasolacrimal duct in the left eye. Topical eyedrop of tobramycin 0.3% and dexamethasone 0.1% were prescribed four times a day. After 2 months of treatment, the patient reported relief from epiphora, and the height of tear meniscus was normalized in both eyes. Conclusion T-DM1 administration in breast cancer treatment can induce lacrimal drainage system stenosis, which can be treated effectively with a topical steroid.

Ocular toxicity associated with anti‐HER2 agents in breast cancer: A pharmacovigilance analysis using the FAERS database

“…Recent case reports have highlighted ocular toxicity associated with anti-HER2 agents. 24,25 Drug-induced ocular toxicity typically involves various structures of the ocular, with particular susceptibility noted in the conjunctiva and corneal. 26 Our analysis revealed varying levels of conjunctival toxicity risk associated with four antibody drugs at the PT or SMQ level, along with novel signals not covered by the drug labels observed in pertuzumab and trastuzumab deruxtecan.…”

“…Recent case reports have highlighted ocular toxicity associated with anti‐HER2 agents 24,25 . Drug‐induced ocular toxicity typically involves various structures of the ocular, with particular susceptibility noted in the conjunctiva and corneal 26 .…”

Bony nasolacrimal duct size and outcomes of nasolacrimal silicone intubation for incomplete primary acquired nasolacrimal duct obstruction

“…Clinical data including symptom duration, exposure to topical antiglaucoma drugs, history of sinusitis, and TMH were collected. Based on DCG, the preoperative NLD stenosis was assessed as follows: 1) extent: diffuse stenosis (length of stenosis > 2 mm) vs. focal stenosis (at 1–4 points) [ 16 ] and 2) degree: severe (faintly visible NLD) vs. weak vs. dilated. The clinical characteristics and bony NLD size parameters of the success and failure groups were compared with Fisher’s exact tests and Mann–Whitney U tests using MedCalc version 9.6.4.0 (MedCalc Software, Mariakerke, Belgium).…”

Toxicity profile of antibody-drug conjugates in breast cancer: practical considerations

“…Therefore, the peripheral cells are the most affected by cytotoxicity, without a significant impact on vision. Tear duct stenosis/swelling was also described with T-DM1 treatment, 59 , 60 probably due to drug excretion in the tears, causing inflammation of the lacrimal ducts, which led to stenosis and epiphora in the long run. This effect was also observed in patients undergoing docetaxel treatment, suggesting that it is related to the DM1 payload.…”