Researchers from the University of Texas MD Anderson Cancer Center in Houston support the latest study conducted by Australian scientists that suggests stenting of the lacrimal duct is not necessary before starting adjuvant docetaxel-based chemotherapy treatment in breast cancer patients.
One of the frequent issues observed with adjuvant docetaxel-based chemotherapy is tearing and varying degrees of other ophthalmological issues, such as irritation of the eyes and discomfort, blurring of vision, disturbances in accommodation, photophobia, mild to moderate conjunctivitis, hyperemia, and redness. However, research conducted by Australian researcher Arlene Chan, MD that is published in Journal of Clinical Oncology suggests that these symptoms are not the result of lacrimal duct obstruction per se.
Dr. Chan, an eminent researcher from Curtin Health Innovation Research Institute in Perth, Australia suggests that surgical stenting is not needed in every patient for the management of tearing in patients receiving adjuvant docetaxel therapy for breast cancer. This is because lacrimal duct obstruction is fairly uncommon in most patients. She advised that tearing can be managed by reassurance and conservative managements like “warmed moistened cloth wiped across the closed eyes and lubricant drops.” In case of severe and persistent symptoms, an ophthalmologist can be consulted.
Editorial by researchers of University of Texas M.D. Anderson Cancer Center:
Bita Esmaeli, MD, and Vicente Valero, MD, eminent researchers from MD Anderson Cancer Center in Houston, supported the study in an editorial and suggested that ophthalmological evaluation is not necessary in most patients; however, regular surveillance, ophthalmological assessment like irrigation and probing is fairly helpful in most cases. In addition, all high risk patients should be assessed and considered for surgical stenting.
The editorial suggested “clinical interventions to manage canalicular stenosis associated with docetaxel are critical to prevent permanent complete closure of canaliculi, the need for complex surgical repair, and poorer clinical outcomes” in high risk groups that include diagnosed patients with partial stenosis and those who are receiving frequent dosing of docetaxel (at least once/ week) or for a longer duration (once every 3 week for long periods).
About tearing, lacrimal duct obstruction and docetaxel-based chemotherapy:
Previous research studies suggested that over 64% of all docetaxel-based chemotherapy recipients complained of tearing. It was believed that obstruction of lacrimal duct is responsible for tearing and pre- chemotherapy stenting was suggested as a solution to manage such cases.
In order to confirm the result of previous research studies, the Australian team of researchers under Arlene Chan conducted a study on 100 patients of early breast cancer with no previous ocular symptoms. All the patients were advised docetaxel-based chemotherapy and lacrimal drainage evaluation was ordered before and after starting chemotherapy.
Details of the study:
Demographics: Mean age of study participants was 52 years (with almost 49% post- menopausal women). 72% participants were diagnosed with stage II breast cancer with 15% and 13% of stage I and III respectively. The following inferences were drawn after assessing the results obtained from patients who underwent chemotherapy:
– During adjuvant chemotherapy, 86% study participants developed tearing
– Most cases of tearing were reported around day 1 of cycle 2 (39%), followed by 30% in cycle 3, 2% in cycle 4, 5% in cycle 5; and in 9%,tearing occurred in cycle 6.
– A higher risk of blepharitis was observed in study participants during the course of therapy (42% vs 37% at baseline)
– No significant difference was observed in the tearing associated with lacrimal duct obstruction at baseline (17% cases) as opposed to those without (94% vs 84%; P = .45) and in patients hwo have tearing associated with punctal stenosis at baseline (27%) as opposed to those without (89% vs 85%).
– At the end of chemotherapy regimen, 4 of 6 patients who developed grade 3 tearing reported complete resolution of symptoms.