Epiphora (excessive tearing) and other ocular manifestations related to weekly docetaxel: underestimated dose-limiting toxicity.
OBJECTIVE
Epiphora due to canalicular stenosis is a recently described side effect of weekly docetaxel. We prospectively evaluated the incidence of this complication and other ocular manifestations in patients treated at our medical center.


METHODS
Twenty-one consecutive patients (breast cancer: 14; metastatic non-small cell lung cancer: 6; metastatic nasopharyngeal carcinoma: 1) (female/male: 14/7; age range: 34-78 yr) were treated with weekly docetaxel (35 mg/m2/wk iv for 6 wk, cycles repeated every 49 d). A standard questionnaire regarding epiphora was completed before each dose of docetaxel. Patients who complained of excessive tearing underwent a thorough ophthalmologic evaluation before receiving the next dose.


RESULTS
Epiphora due to stenosis of the lacrimal puncti and canaliculi developed in seven (33%) patients following a cumulative dose of 208-645 mg/m2 (median: 400 mg/m2). Two patients developed complete canalicular stenosis requiring surgery. Epiphora was accompanied by madarosis and ectodermalization of the palpebral and bulbar conjunctiva, complete in five patients. Treatment was discontinued due to epiphora in two (10%) patients. After a median follow-up of 11 mo, four patients still had epiphora.


CONCLUSIONS
Epiphora due to canalicular stenosis is a frequent complication of weekly docetaxel and might be dose limiting. Irreversible damage requiring surgical intervention may develop despite close monitoring.
Tsalic
Medy
M
Department of Oncology, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Gilboa
Michael
M
Visel
Bela
B
Miller
Benjamin
B
Haim
Nissim
N
D000328:Adult; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D000077143:Docetaxel; D005260:Female; D006801:Humans; D007766:Lacrimal Apparatus Diseases / Q000139:chemically induced*; D007767:Lacrimal Duct Obstruction / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects*
D000972:Antineoplastic Agents, Phytogenic; D043823:Taxoids; D000077143:Docetaxel