vis-a-vis dry eye/tearing as a side effect of herceptin

[Lani]

it may be a side effect of taxanes, and one which is delayed at that:

1: J Clin Oncol. 2006 Aug 1;24(22):3619-22. Links
Prospective study of incidence and severity of epiphora and canalicular stenosis in patients with metastatic breast cancer receiving docetaxel.

Esmaeli B,
Amin S,
Valero V,
Adinin R,
Arbuckle R,
Banay R,
Do KA,
Rivera E.
Section of Ophthalmology, Division of Pharmacy, Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. besmaeli@mdanderson.org
PURPOSE: To determine the incidence and severity of epiphora and canalicular stenosis in patients receiving docetaxel weekly or every 3 weeks. PATIENTS AND METHODS: In this prospective trial, each patient underwent an ophthalmologic examination and probing and irrigation of the lacrimal drainage apparatus at baseline and every 4 to 6 weeks after initiation of docetaxel. During each visit, epiphora and canalicular stenosis were graded. Patients with epiphora were treated with tobramycin and dexamethasone drops. If epiphora worsened or if findings on probing and irrigation suggested further canalicular narrowing, silicone intubation was offered. RESULTS: Twenty-eight patients received docetaxel weekly, and 28 patients received docetaxel every 3 weeks. Eighteen patients (64%) who received weekly docetaxel developed epiphora. Epiphora was mild in seven patients, moderate in five, and severe in six. Nine patients had resolution of epiphora with tobramycin and dexamethasone administration. Nine patients had worsened canalicular stenosis; six underwent surgery. The median cumulative docetaxel dose was 496.5 mg at onset of epiphora and 889.5 mg at surgery. Eleven patients (39%) who received docetaxel every 3 weeks developed epiphora. The median cumulative docetaxel dose at onset of epiphora in this group was 420 mg. Epiphora was mild in nine patients, moderate in one, and severe in one. Nine patients had resolution of epiphora with tobramycin and dexamethasone administration. Two patients underwent surgery. CONCLUSION: Epiphora occurred in 64% of patients in the weekly group and in 39% of patients in the every-3-weeks group. Moderate or severe canalicular stenosis was seen in about one-third of patients in the weekly group and in none of the patients in the every-3-weeks group.
PMID: 16877729 [PubMed - in process]

[Sherryg683]

My eyes teared terribly while I was on Taxotere. It looked like I was crying all the time, mainly my right eye. My Oncologist prescribed me a steriod eyedrop which helped some...sherryg683

[Lisa]

Lani,

As a non-medical reader and a HER2 patient with constant tearing during the past 3 years, AND have an appointment with an opthamologist Aug. 22, can you please translate your post?

Thanks.

Love and light,

Lisa

[Sheila]

Lisa
I had the silicone stints put in my tear glands for this...the first time they used collagen, which seemed to help, then the next time silicone...I was so hopeful...within a week I was a "CRYBABY" again.....guess the 400.00 each treatment cost would have bought alot of Kleenex. I have always had the Runny eyes since Herceptin, but they were 10 times worse on Xeloda....you are on that too aren't you....my onc said she sees this alot with Xeloda. Now that i am off the Xeloda for a period of time, I will see if it improves.

[Lani]

the easiest way to "translate" this medical "gibberish" is to go to google.

Epiphora means excessive tearing of the eye due to lack of adequate draining of the tears produced. Docetaxel seems to be the culprit in this study and not herceptin ==as most have a taxane before/with Herceptin it may be a delayed side-effect of the taxane that many are attributing to Herceptin (although I have read papers that Herceptin alone can cause dry eyes --I seem to remember that it was due to less tears produced, but would have to go back and read it again)

In any case, this article shows that tearing due to decreased drainage was worse with every week vs every three week treatment (with 64% of the weekly patients and 39% of the every three week patients having excess tearing due to insufficient drainage of tears. It seems to respond to steroid plus an antibiotic (tobramycin) , but sometimes became chronic and required silicon plug treatment.

It seems the cumulative dosage of the taxane seemed to be what caused the problem, with higher cumulative doses causing canicular stenosis (narrow of the canal which drains the tears from the eye) and not JUST excess tearing itself. It was the canicular stenosis associated with higher cumulative doses that usually ended up requiring surgery.

Hope this helps (do try Google though!)--No, I do not own stock in Google!