• Cataract/Anterior Segment, Comprehensive Ophthalmology, Ocular Pathology/Oncology, Oculoplastics/Orbit, Retina/Vitreous

    Review of: Risk of ocular adverse events with taxane-based chemotherapy

    Sodhi M, Yeung S, Maberley D, et al. JAMA Ophthalmology, September 2022

    A retrospective study comparing women patients being treated with taxanes vs. tamoxifen for breast cancer found increased risks of epiphora, cystoid macular edema, and optic neuropathy in the taxanes group.

    Study design 

    In this retrospective study, a cohort of women who were new users of taxanes (docetaxel or paclitaxel) were compared with a cohort of women who were new users of tamoxifen for the treatment of estrogen-positive breast cancer. The PharMetrics Plus database, a private health-claims database that captures health information of more than 150 million enrollees in the US, was used as the primary data source for the study. The outcomes of the study included (1) epiphora, (2) cystoid macular edema (CME), and (3) optic neuropathy (ischemic or toxic).

    Outcomes

    The epiphora and optic neuropathy analyses included 18,219 users and the CME analysis included 18,433 users. The study showed higher rates of epiphora (adjusted hazard ratio [HR] 5.15, confidence interval [CI] 2.79–9.54) and optic neuropathy (adjusted HR 4.44, CI 1.04–18.87) among the taxane users compared with the tamoxifen users. The results also suggested an increased risk of CME (adjusted HR 1.33) among taxane users although the confidence interval was wide-ranging from 0.70 to 2.53.

    Limitations

    The study does not provide data regarding the primary cancer for which the taxanes were used. Moreover, there is no data available in regard to other chemotherapeutic agents used in conjunction with taxanes. As the study included only women, the findings are not applicable to men. It should be emphasized that this study is based on claims data, and the researchers of this retrospective study were not able to validate the outcomes of the study.

    Clinical significance

    Taxanes are a commonly used chemotherapeutic agent for breast cancer with about 60% of these patients undergoing taxane-based chemotherapy at some point during the course of their treatment.  As the authors mention in their discussion, the use of taxanes is expected to increase over the next few years for treatment of breast, lung, genitourinary, and head and neck cancers, among others. It is therefore important for the treating physicians and ophthalmologists to be familiar with the adverse effects of taxanes, as early identification and treatment of these events may be associated with improved outcomes.