Cystoid Macular Edema during Treatment with Paclitaxel and Bevacizumab in a Patient with Metastatic Breast Cancer: A Case Report and Literature Review

Abstract

We present a case of a metastatic breast cancer patient with cystoid macular edema (CME) occurring during treatment with paclitaxel and bevacizumab. She had a history of neoadjuvant chemotherapy and partial mastectomy plus axillary lymph node dissection for stage IIB left-breast cancer. Twenty-four months later, she was diagnosed with multiple bone metastases and underwent chemotherapy with paclitaxel and bevacizumab. Thirty-three months after the initiation of the chemotherapy, she noticed bilateral blurred vision. The retinal thickening with macular edema was observed by optical coherence tomography, resulting in a diagnosis of CME. With cessation of paclitaxel and administrating ocular instillation of a nonsteroidal anti-inflammatory drug, her macular edema gradually reduced and disappeared in a month. While CME caused by chemotherapy is very rare, taxane may cause ocular adverse events such as CME. It is important to urge patients to consult an ophthalmologist promptly when they have visual complaints during taxane chemotherapy.

Chemotherapy-induced cystoid macular edema in ovarian cancer

“…Although rare, cystoid macular edema has been previously reported as an adverse event of paclitaxel [1][2][3][4][5]. This adverse event generally occurs within 6-12 months from the start of paclitaxel treatment [3]; in the present patient, it is highly likely that the symptoms appeared due to the multiple courses of paclitaxel treatment. In contrast, the visual abnormality caused by cystic macular edema occurred just after the treatment regimen was changed to bevacizumab.…”

“…Therefore, the regimen change of paclitaxel or bevacizumab might itself be the cause of macular edema. Some cases with macular edema caused by using paclitaxel and bevacizumab have been reported in patients with breast cancer, and in one case, such symptoms improved by simply terminating paclitaxel and using bevacizumab alone [3].…”

Paclitaxel-associated Retinopathy in a Female Patient with Breast Cancer

“…Although large case series regarding treatment are lacking, discontinuation of paclitaxel is generally accepted as the treatment of choice for paclitaxel-associated retinopathy. Several adjunctive therapies have also been suggested, including topical steroids and non-steroidal anti-inflammatory drugs, oral acetazolamide, and topical dorzolamide [10,[12][13][14]. In our case, the first intravitreal bevacizumab injection resulted in significant improvement of CME at 3 days, but this improvement did not persist over 1 month.…”

“…Paclitaxel-associated retinopathy presents as a form of CME, but there is usually minimal leakage or staining on FA [6,11,12,15]. In addition, paclitaxel-associated retinopathy has appeared in patients who underwent concomitant chemotherapy with paclitaxel and bevacizumab [10]. Intravitreal bevacizumab injections were not effective for reducing CME in previous cases either, although vision was preserved [12].…”

“…The exact mechanism of paclitaxel-associated retinopathy is unclear, and currently the best treatment is cessation of paclitaxel [6][7][8][9][10][11][12][13][14][15]. Other adjuvant treatments have been reported, such as intravitreal bevacizumab injection [12], topical or intraocular steroid treatment, oral acetazolamide [13], topical non-steroidal anti-inflammatory drugs [10], and topical dorzolamide [14]. Here, we describe a case of paclitaxel-associated retinopathy in a 53-year-old female patient with breast cancer who could not stop paclitaxel.…”