Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY, USA.
Anticancer Res. 2012 Apr;32(4):1375-7.
Gastrointestinal stromal tumor (GIST) is a mesenchymal malignancy of the gastrointestinal tract. Imatinib mesylate (Gleevec(®), ST1571, Novartis Pharmaceuticals, Basel, Switzerland) is a selective inhibitor of break point cluster-Ableson (BCR-ABL), c-Kit, and platelet-derived growth factor receptor alpha (PDGFRα) tyrosine kinases. Imatinib has been approved in the U.S. for the treatment of Philadelphia-chromosome positive chronic myeloid leukemia, KIT (CD117)-positive unresectable and metastatic malignant GIST and adjuvant treatment of adult patients following resection. Ocular side effects are commonly reported with Gleevec(®), the most common being periorbital edema and epiphora.
Here we present the case of a 62-year-old male with a history of GIST in the jejunum who was started with imatinib mesylate at 400 milligrams daily. Seven months into his therapy, he reported blurry vision. He was evaluated by an ophthalmologist, and was ultimately found to have retinal hemorrhage and neovascularization. His dose was reduced by 50% to 200 milligrams daily with an almost complete resolution of symptoms within several weeks. No recurrence of symptoms or signs was noticed at 6 months follow-up.
This patient's Naranjo scale was calculated to be 7, indicating a probable adverse drug reaction. Our patient's symptoms significantly improved with a dose reduction of imatinib, and this hints that there was a dose-dependent effect. The World Health Organization has categorized retinal hemorrhage as an unlikely side-effect of therapy, and to our knowledge this has never been reported before in a patient receiving imatinib mesylate for GIST treatment. Neovascularization also has not been previously reported in patients receiving this medication. It is important to identify less common ocular toxicity in patients receiving imatinib.
胃肠道间质瘤（GIST）是一种胃肠道间叶恶性肿瘤。甲磺酸伊马替尼（格列卫®，ST1571，诺华制药，巴塞尔，瑞士）是一种针对断裂点簇集-Ableson（BCR-ABL）、c-Kit 和血小板衍生生长因子受体α（PDGFRα）酪氨酸激酶的选择性抑制剂。伊马替尼已在美国获准用于治疗费城染色体阳性慢性髓性白血病、KIT（CD117）阳性不可切除和转移性恶性 GIST 以及成人患者手术后的辅助治疗。格列卫®常报告眼部副作用，最常见的是眶周水肿和溢泪。
这里我们报告了一例 62 岁男性小肠 GIST 病史，每日接受 400 毫克甲磺酸伊马替尼治疗。在他接受治疗的七个月后，他报告视力模糊。他由眼科医生进行评估，最终发现视网膜出血和新生血管形成。他的剂量减少了 50%，降至每日 200 毫克，几周内症状几乎完全缓解。在 6 个月的随访中，没有发现症状或体征的复发。
该患者的 Naranjo 量表评分为 7，表明可能存在药物不良反应。我们患者的症状在伊马替尼剂量减少后明显改善，这表明存在剂量依赖性效应。世界卫生组织将视网膜出血归类为治疗不太可能的副作用，据我们所知，在接受伊马替尼治疗 GIST 的患者中，这从未有过报道。新生血管化也从未在接受这种药物治疗的患者中报道过。在接受伊马替尼治疗的患者中识别不太常见的眼部毒性非常重要。
