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

BMC Ophthalmology

Amardeep Sekhon¹  Sonia N. Yeung²  Johnson C. H. Tan³  Simon P. Holland⁴  Jeff Y. F. Wang⁵ 

[1] Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada;Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada;Eye Care Centre, Vancouver Hospital, 2550 Willow Street, V5Z 3N9, Vancouver, BC, Canada;Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada;National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore;Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada;Pacific Laser Eye Centre, Vancouver, Canada;Faculty of Medicine, University of British Columbia, Vancouver, Canada;

关键词: Limbal stem cell deficiency;    Paclitaxel;    Chemotherapy;    Breast cancer;    Keratitis;   

DOI  :  10.1186/s12886-020-01672-x

来源: Springer

【 摘 要 】

BackgroundPaclitaxel (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 presentationA 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.ConclusionAlthough 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.

【 授权许可】

CC BY