Ocular toxicity during adjuvant chemoendocrine therapy for early breast cancer: results from International Breast Cancer Study Group trials.
BACKGROUND
Others have reported ocular toxicity after adjuvant chemoendocrine therapy, but this study looked at ocular toxicity in similarly treated patients from large randomized clinical trials.


METHODS
Information was retrieved on incidence and timing of ocular toxicity from the International Breast Cancer Study Group (IBCSG) database of 4948 eligible patients randomized to receive tamoxifen or toremifene alone or in combination with chemotherapy (either concurrently or sequentially). Case reports of patients with ocular toxicity were evaluated to determine whether ocular toxicity occurred during chemotherapy and/or hormonal therapy. Additional information was obtained from participating institutions for patients in whom ocular toxicity occurred after chemotherapy but during administration of tamoxifen or toremifene.


RESULTS
Ocular toxicity was reported in 538 of 4948 (10.9%) patients during adjuvant treatment, mainly during chemotherapy. Forty-five of 4948 (0.9%) patients had ocular toxicity during hormone therapy alone, but only 30 (0.6%) patients had ocular toxicity reported either without receiving any chemotherapy or beyond 3 months after completing chemotherapy and, thus, possibly related to tamoxifen or toremifene. In 3 cases, retinal alterations, without typical aspects of tamoxifen toxicity, were reported; 4 patients had cataract (2 bilateral), 12 impaired visual acuity, 10 ocular irritation, 1 optical neuritis, and the rest had other symptoms.


CONCLUSIONS
Ocular toxicity during adjuvant therapy is a common side effect mainly represented by irritative symptoms due to chemotherapy. By contrast, ocular toxicity during hormonal therapy is rare and does not appear to justify a regular program of ocular examination. However, patients should be informed of this rare side effect so that they may seek prompt ophthalmic evaluation for ocular complaints.
Gianni
Lorenzo
L
Division of Oncology and Hematology, Hospital degli Infermi, Rimini, Italy. lgianni@auslrn.net
Panzini
Ilaria
I
Li
Sigui
S
Gelber
Richard D
RD
Collins
John
J
Holmberg
Stig B
SB
Crivellari
Diana
D
Castiglione-Gertsch
Monica
M
Goldhirsch
Aron
A
Coates
Alan S
AS
Ravaioli
Alberto
A
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D016208:Databases, Factual; D005123:Eye / Q000187:drug effects; D005128:Eye Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013629:Tamoxifen / Q000009:adverse effects*; D017312:Toremifene / Q000009:adverse effects*; D014792:Visual Acuity
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D017312:Toremifene