Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, South Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
BMC Cancer. 2019 Aug 6;19(1):774. doi: 10.1186/s12885-019-5986-5.
Trastuzumab emtansine (Kadcyla®, T-DM1) is an antibody-drug conjugate used to treat HER2 (human epidermal growth factor receptor 2) overexpressing metastatic breast cancer. In this report, we present the first case of lacrimal drainage system stenosis identified after T-DM1 administration, and its successful treatment with a topical steroid.
A 36-year-old female with metastatic breast cancer was referred for excessive tearing of both eyes. She previously underwent mastectomy and was treated with multiple anti-cancer regimens. However, metastases to liver and bone were identified and T-DM1 was administered. After 2 months, epiphora developed in both eyes and the patient was referred for ophthalmologic examination. The height of the tear meniscus was increased. The fluorescein dye disappearance test (FDDT) showed a delayed clearance in both eyes. Diagnostic lacrimal probing demonstrated a lower distal canalicular stenosis in both eyes. Dacryocystography indicated multiple focal narrowing of nasolacrimal duct in the right eye and diffused narrowing of nasolacrimal duct in the left eye. Topical eyedrop of tobramycin 0.3% and dexamethasone 0.1% were prescribed four times a day. After 2 months of treatment, the patient reported relief from epiphora, and the height of tear meniscus was normalized in both eyes.
T-DM1 administration in breast cancer treatment can induce lacrimal drainage system stenosis, which can be treated effectively with a topical steroid.
曲妥珠单抗-美坦新偶联物（Kadcyla®，T-DM1）是一种用于治疗人表皮生长因子受体 2（HER2）过表达的转移性乳腺癌的抗体药物偶联物。在此报告中，我们介绍了首例在 T-DM1 给药后发生的泪道系统狭窄病例，并成功采用局部皮质类固醇进行了治疗。
一名 36 岁女性，患有转移性乳腺癌，因双眼溢泪过多而就诊。她曾行乳房切除术，并接受了多种抗癌方案治疗。然而，发现肝和骨转移，开始使用 T-DM1。2 个月后，她双眼出现流泪，并被转诊进行眼科检查。泪膜高度增加。荧光素染料消失试验（FDDT）显示双眼清除延迟。诊断性泪道探通术显示双眼下泪小管远端狭窄。泪道造影显示右眼鼻泪管多处狭窄，左眼鼻泪管弥漫性狭窄。给予妥布霉素 0.3%和地塞米松 0.1%滴眼剂，每天四次。治疗 2 个月后，患者溢泪症状缓解，双眼泪膜高度恢复正常。
乳腺癌治疗中 T-DM1 的给药可能会导致泪道系统狭窄，局部皮质类固醇可有效治疗。
