Limbal stem cell deficiency secondary to systemic paclitaxel (Taxol) for breast cancer: a case report

Abstract

Background Paclitaxel (PTX) is an antineoplastic drug widely used in treatments for ovarian, breast, and small-cell lung cancer. Although ocular effects associated with PTX have been previously described, very few studies have specifically reported systemic PTX as a contributing factor for limbal stem cell deficiency (LSCD), which is characterized by the loss of stem cell and barrier function of the limbus leading to progressive pain and reduction in visual acuity. Described here is a unique case where a patient was diagnosed with LSCD secondary to PTX use for the treatment of breast cancer, at doses of PTX far lower than what is reported in current literature. Case presentation A 73-year-old woman with a previous diagnosis of breast cancer with liver metastasis presented with a complaint of increasing pain in the left eye more than the right, along with decreasing visual acuity in both eyes following 3 months of PTX therapy for recurrent liver metastases. Upon examination, best-corrected visual acuity was 20/100 in the right eye and counting fingers on the left. Peripheral neovascularization, stromal scarring, and features of limbal stem cell deficiency (LSCD) were noted on the right cornea. A central neurotrophic ulcer with thinning to 50% and 360 degrees of conjunctivalization were noted on the left. After the discontinuation PTX with doxorubicin as the substitute, there was no further progression of her LSCD, and stabilization of her ocular surface was achieved. Conclusion Although chemotherapy induced LSCD is a relatively rare adverse event, it is essential for clinicians starting new chemotherapy agents to consider the potential ocular toxicities that may result in their use. Ophthalmology review is recommended for patients after starting PTX therapy to assess for signs of LSCD, particularly in patients where drug toxicity can be aggravated due to impaired hepatic function.

Neurotrophic Keratopathy in Systemic Diseases: A Case Series on Patients Treated With rh-NGF

“…The effects of the different therapies of cerebral tumors such as surgery ( 19 – 22 ) radiotherapy, ( 23 ) and systemic chemotherapy ( 24 , 25 ) may also alter the nerve fibers or induce limbal stem cell deficiency ( 26 , 27 ) resulting clinically in NK.…”

Taxane therapy associated adverse ocular reactions

“…The most common symptoms are discomfort of the eyelids, conjunctiva and lacrimal gland organs, including dry eye [2], nasolacrimal duct obstruction [16], lacrimal duct obstruction [16][17][18], erosive conjunctivitis and punctate stenosis [4], corneal epithelial lesions [19,20], and limbal stem cell deficiency [3]. The obstruction of nasolacrimal duct may be related to the interstitial fibrosis of lacrimal duct mucosa [16].…”

“…However, in recent years, there have been reports of adverse ocular reactions caused by taxane drugs. Such as vision loss [1], dry eye [2], lacrimal duct obstruction [3], conjunctivitis [4], glaucoma [5], optic neuropathy [6], macular edema [7,8], blindness caused by combination with cisplatin [9], and so on. These adverse side effects have numerous effects on patients' life quality and their compliance to the therapy.…”

Evaluation of phytochemical responses and paclitaxel content of yew (Taxus baccata) seedlings subjected to the systemic fungicides

“…Apart from fresh fruits, leaves, bark, seeds and branches contain a combination of alkaloids, diterpenoids, ligands, tannins and resins and the plant's organs are highly toxic (Labossiere & Thompson, 2018). The yew tree is the primary source of the anti‐cancer compound taxol (El‐Sayed et al., 2020; Sekhon et al., 2020). This compound is present in all parts of the yew plant species except its fresh fruit (Naik, 2019).…”