Ophthalmologists need to be aware of ocular surface adverse events with oncology therapies
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Ophthalmologists must work with oncologists to understand and mitigate ocular surface adverse events caused by oncologic therapeutics, according to a presentation at Real World Ophthalmology.
Antibody-drug conjugate (ADC) therapy is a promising approach in cancer treatment that entails linking cytotoxic drugs to antibodies for targeted delivery. However, ADCs have demonstrated an ocular surface adverse event profile that may include symptoms such as blurred vision, tearing, foreign body sensation, photophobia and pain along with signs such as epithelial changes, topographical changes, refractive error changes and more, Laura M. Periman, MD, said.
“We think that, even though there is not a direct target on the corneal epithelial cells, that somehow they are endocytosing these ADCs either through limbal stem cell delivery or tear film delivery — that’s not clear either — creating these intracellular damage effects and a bystander damage effect,” she said.
Periman highlighted research that found that in 464 patients treated with mirvetuximab, a folate receptor alpha-targeting ADC, 50% experienced at least one ocular adverse event, the majority of which were grade 2 or less. No corneal ulcers or perforations were seen.
“There does seem to be a dose- and duration-dependent relationship to these corneal complications, and they seem to be largely reversible,” she said.
Treatment options include steroid drops, which may help prevent apoptosis of damaged basal corneal epithelial cells, and artificial tears. Management strategies should include a multidisciplinary approach with ophthalmologists and oncologists working together.
“We need to talk to each other about these things we are seeing with these exciting new therapeutics that really can save lives,” Periman said.
Education is needed for health care professionals and patients about ocular side effects, along with the implementation of proactive monitoring protocols. Ophthalmic monitoring during clinical trials and therapeutic treatments includes slit lamp examination, corneal topography, tear film assessment and refractions.
“Rather than pull someone off of a potentially lifesaving medication, we can provide supportive care, anticipatory guidance and a reassurance that these things can improve over time,” Periman said.
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Periman LM. Corneal considerations with oncologic therapeutics. Presented at: Real World Ophthalmology; April 27, 2024 (virtual meeting).
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