Canalicular stenosis secondary to weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.
OBJECTIVE
To compare the frequency of canalicular stenosis as a side effect of weekly versus every-3-weeks docetaxel in patients with metastatic breast cancer.


METHODS
Retrospective nonrandomized comparative trial.


METHODS
Eighteen patients enrolled in a phase II study of weekly docetaxel plus trastuzumab and 18 patients enrolled in a phase II study of every-3-weeks docetaxel plus doxorubicin were evaluated. Each patient underwent a comprehensive ophthalmologic examination, probing and irrigation of the nasolacrimal duct, and, in some instances, a nuclear lacrimal scan.


METHODS
If epiphora (excessive tearing) was reported by the patient, its time of onset was documented. In patients with epiphora, presence or absence of canalicular stenosis was evaluated on the basis of the findings on probing and irrigation. The duration of treatment with docetaxel, the dose frequency, and the cumulative dose of docetaxel were recorded in each case.


RESULTS
Fourteen patients (77%) receiving weekly docetaxel plus trastuzumab had epiphora. Nine of these patients had significant anatomic narrowing of the canaliculi. Bicanalicular silicone intubation or dacryocystorhinostomy was recommended in all nine patients. Eight patients underwent surgery and experienced complete or near complete resolution of epiphora. Although two patients (11%) receiving every-3-weeks docetaxel plus doxorubicin reported transient symptoms of epiphora, neither patient was found to have narrowing of the canaliculi, and the epiphora was not severe enough to justify surgical intervention. The mean duration of docetaxel therapy for the patients in this study was 19 weeks. The mean cumulative dose of docetaxel was higher in patients with canalicular stenosis than in patients without this side effect.


CONCLUSIONS
Canalicular stenosis was more common in patients receiving weekly docetaxel than in those receiving every-3-weeks docetaxel for metastatic breast cancer. Bicanalicular silicone intubation early in the course of weekly docetaxel therapy should be considered, because this intervention can prevent complete closure of the canaliculi. Once complete or near complete stenosis of the canaliculi occurs, placement of a permanent Pyrex glass tube may become necessary to overcome the blockage of tear outflow.
Esmaeli
Bita
B
Ophthalmology Section, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Hortobagyi
Gabriel N
GN
Esteva
Francisco J
FJ
Booser
Daniel
D
Ahmadi
M Amir
MA
Rivera
Edgardo
E
Arbuckle
Rebecca
R
Delpassand
Ebrahim
E
Guerra
Laura
L
Valero
Vicente
V
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000556:secondary; D000077143:Docetaxel; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007440:Intubation; D007765:Lacrimal Apparatus / Q000187:drug effects*; D007767:Lacrimal Duct Obstruction / Q000139:chemically induced* / Q000628:therapy; D008875:Middle Aged; D017239:Paclitaxel / Q000009:adverse effects* / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D043823:Taxoids; D000068878:Trastuzumab
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D000068878:Trastuzumab; D017239:Paclitaxel