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Corneal features in trastuzumab emtansine treatment: not a rare occurrence

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Abstract

Purpose

Ado-trastuzumab emtansine (T-DM1/Kadcyla®;Genentech) is an antibody-drug conjugate used in the treatment of human epidermal growth factor receptor-2-positive metastasized breast cancer. Few studies report a spectrum of corneal changes in patients treated with this drug. Our aim is to specify the nature and prevalence of corneal features of T-DM1 treatment in order to formulate guidelines as to which findings necessitate systemic treatment cessation or dose reduction.

Methods

We performed a cross-sectional, prospective study in all patients currently treated with T-DM1 or recently stopped in Ghent University Hospital, Belgium.

Results

A total of 12 patients completed a full ophthalmic workup. Ten patients were currently using T-DM1, and two patients had recently (< 10 weeks) stopped treatment because of clinical non-response. Twenty eyes of 10 patients currently on T-DM1-treatment all exhibited coarse cystoid lesions to the deep corneal epithelial cells, primarily in the midperipheral area, both biomicroscopically and on confocal microscopy. The two patients who stopped treatment, displayed no corneal epithelial changes. Only three patients reported symptoms which were attributed to other ocular factors, likely not to be related to T-DM1 treatment.

Conclusions

This case series shows that asymptomatic, low-grade corneal epithelial changes are hallmark features in T-DM1-treatment and should not alarm clinicians. These findings are relatively stationary, reversible and thus do not require ocular treatment or cessation of systemic treatment.

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Data availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ADC:

Antibody-drug conjugate

BCVA:

Best-corrected visual acuity

EGFR:

Epidermal growth factor receptor

HER-2:

Human epidermal growth factor receptor-2

RE:

Right eye

LE:

Left eye

T-DM1:

Ado-trastuzumab emtansine

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Authors and Affiliations

  1. Department of Ophthalmology, Ghent University Hospital, 10, Corneel Heymanslaan, 9000, Ghent, Belgium

    Els Deklerck & Elke O. Kreps

  2. Department of Medical Oncology, Ghent University Hospital, 10, Corneel Heymanslaan, 9000, Ghent, Belgium

    Hannelore Denys

Authors
  1. Els Deklerck
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  2. Hannelore Denys
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  3. Elke O. Kreps
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Corresponding author

Correspondence to Els Deklerck.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors declare that the experiments comply with the current laws of the country in which they were performed (Belgium). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Deklerck, E., Denys, H. & Kreps, E.O. Corneal features in trastuzumab emtansine treatment: not a rare occurrence. Breast Cancer Res Treat 175, 525–530 (2019). https://doi.org/10.1007/s10549-019-05179-y

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  • DOI: https://doi.org/10.1007/s10549-019-05179-y

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