Ocular toxicity during adjuvant chemoendocrine therapy for early breast cancer

Abstract

BACKGROUND Others have reported ocular toxicity after adjuvant chemoendocrine therapy, but this study looked at ocular toxicity in similarly treated patients from large randomized clinical trials. METHODS Information was retrieved on incidence and timing of ocular toxicity from the International Breast Cancer Study Group (IBCSG) database of 4948 eligible patients randomized to receive tamoxifen or toremifene alone or in combination with chemotherapy (either concurrently or sequentially). Case reports of patients with ocular toxicity were evaluated to determine whether ocular toxicity occurred during chemotherapy and/or hormonal therapy. Additional information was obtained from participating institutions for patients in whom ocular toxicity occurred after chemotherapy but during administration of tamoxifen or toremifene. RESULTS Ocular toxicity was reported in 538 of 4948 (10.9%) patients during adjuvant treatment, mainly during chemotherapy. Forty‐five of 4948 (0.9%) patients had ocular toxicity during hormone therapy alone, but only 30 (0.6%) patients had ocular toxicity reported either without receiving any chemotherapy or beyond 3 months after completing chemotherapy and, thus, possibly related to tamoxifen or toremifene. In 3 cases, retinal alterations, without typical aspects of tamoxifen toxicity, were reported; 4 patients had cataract (2 bilateral), 12 impaired visual acuity, 10 ocular irritation, 1 optical neuritis, and the rest had other symptoms. CONCLUSION Ocular toxicity during adjuvant therapy is a common side effect mainly represented by irritative symptoms due to chemotherapy. By contrast, ocular toxicity during hormonal therapy is rare and does not appear to justify a regular program of ocular examination. However, patients should be informed of this rare side effect so that they may seek prompt ophthalmic evaluation for ocular complaints. Cancer 2006. © 2005 American Cancer Society.

Critical illness and changes in sensory perception

“…One study shows the prevalence of ocular toxicity from chemotherapy to be 10 . 9% (Gianni et al 2006). Fenretinide, a synthetic derivative of retinoic acid that has been studied clinically for cancer prevention, causes alterations in dark adaptation (Baglietto et al 2000).…”

Crystalline maculopathy: A rare complication of tamoxifen therapy

“…This incidence can increase to 10.9% with the use of chemotherapy. [3] Tamoxifen-induced maculopathy is a rare entity. The first case of ocular toxicity due to tamoxifen was reported by Kaiser-Kupfer and Lippman in 1978 and referred to women receiving extremely high doses of tamoxifen (240-320 mg/day) for metastatic breast cancer.…”

“…[2] Ocular complications are rare with tamoxifen therapy (0.6%) and include cataract, vortex keratopathy, optic neuritis and retinopathy. [3] Here we report a rare case of crystalline maculopathy secondary to tamoxifen therapy.…”

An investigation of the visual disturbances experienced by patients on clomiphene citrate

“…Patients reporting visual side effects are usually immediately discontinued from CC therapy, for fear of irreversible retinal damage. This course of action is based on case reports (7,8,14,15) and on the retinal toxicity associated with tamoxifen, which has a similar estrogen receptor inhibitor action to CC (16)(17)(18)(19)(20). As a result, some women are denied the opportunity to use a cost effective and noninvasive infertility therapy.…”