Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, United States.
Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL 60612, United States.
Oncologist. 2024 Nov 4;29(11):e1435-e1451. doi: 10.1093/oncolo/oyae177.
Antibody-drug conjugates (ADCs) are a fast-growing class of cancer drugs designed to selectively deliver cytotoxic payloads through antibody binding to cancer cells with high expression of the target antigen, thus reducing systemic exposure and minimizing off-target effects. However, ADCs are associated with various ocular adverse events (AEs) that may impact treatment administration and patient outcomes. In this review, we provide a summary of ocular AEs associated with approved and investigational ADCs, recommendations for the mitigation and management of ocular AEs, current guidelines and expert opinions, and recommendations for clinical practice. A literature search was performed, using PubMed and Google Scholar, for English-language articles published between January 1985 and January 2023 to identify studies reporting ocular AEs associated with ADC use. Search terms included generic and investigational names of all identified ADCs, and further searches were performed to identify strategies for managing ADC-associated ocular AEs. ADC-associated ocular AEs include symptoms such as blurred vision and foreign-body sensation and signs such as corneal fluorescein staining, corneal pseudomicrocysts, and conjunctivitis. Reported management strategies include ADC dose modification (eg, dose delay or reduction), cool compresses, artificial tears, topical vasoconstrictors, and topical steroids. Although ADC dose modification appears to be beneficial, the preventive and/or therapeutic benefits of the remaining interventions are unclear. Although the exact mechanisms are not fully understood, most ADC-associated ocular AEs are reversible with dose delay or dose reduction. Management of ocular AEs requires a multidisciplinary approach to minimize treatment discontinuation and optimize clinical outcomes.
抗体药物偶联物（ADCs）是一类快速发展的癌症药物，旨在通过抗体与靶抗原高表达的癌细胞结合，选择性地输送细胞毒性有效载荷，从而减少全身暴露并最大限度地减少脱靶效应。然而，ADCs 与各种眼部不良事件（AEs）相关，这些事件可能会影响治疗的实施和患者的结局。在这篇综述中，我们总结了与已批准和正在研究的 ADC 相关的眼部 AEs，提出了缓解和管理眼部 AEs 的建议，介绍了现有的指南和专家意见，以及临床实践的建议。使用 PubMed 和 Google Scholar 进行了英文文献检索，检索了 1985 年 1 月至 2023 年 1 月期间发表的与 ADC 使用相关的眼部 AEs 的研究报告。检索词包括所有已识别 ADC 的通用名和研究用名，并进一步检索了用于管理 ADC 相关眼部 AEs 的策略。与 ADC 相关的眼部 AEs 包括视力模糊和异物感等症状，以及角膜荧光素染色、角膜微囊泡和结膜炎等体征。报告的管理策略包括 ADC 剂量调整（如剂量延迟或减少）、冷敷、人工泪液、局部血管收缩剂和局部类固醇。虽然 ADC 剂量调整似乎是有益的，但其余干预措施的预防和/或治疗益处尚不清楚。尽管确切的机制尚未完全了解，但大多数与 ADC 相关的眼部 AEs 可以通过延迟或减少剂量来逆转。眼部 AEs 的管理需要采取多学科方法，以最大限度地减少治疗中断并优化临床结局。
