Newly Recognized Ocular Side Effects of Erlotinib

Methvin, Amanda; Gausas, Roberta E.

doi:10.1097/iop.0b013e31802d97f0

Cited by 43 publications

(34 citation statements)

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“…3 These ocular side effects may be associated with inhibition of EGFR which is expressed on corneal, limbal and conjunctival epithelium, however, the exact mechanism still remains elusive. In the previously reported cases of erlotinib-related ectropion, time onset of ectropion ranged between the first and sixth week of erlotinib treatment, [4][5][6] while it was approximately the fourth week of treatment in the present case. Preceding papulopustular rash associated with erlotinib treatment in our case may have been producing cicatricial traction leading to ectropion development and age related lid laxity may have been contributing to it.…”

Section: Discussionmentioning

confidence: 79%

“…2 Ocular toxicity may also occur with erlotinib treatment. [3][4][5][6] In a recent review of 69 cases with EGFR inhibitors related ocular toxicity, the most common ocular side effects were dysfunctional tear syndrome, blepharitis, trichomegaly and trichiasis. Other less common toxicities included conjunctivitis, keratitis, corneal ulceration, chalazion and ectropion.…”

Section: Discussionmentioning

confidence: 99%

“…However, eye toxicity have also been reported to appear independent of the papulopustular lesions of the face. [3][4][5] Ectropion development have been described in association with other anticancer agents as well such as cetuximab and 5-fluorouracil (5-FU). 7,8 In the cetuximab associated case, concomitant use of 5-FU raised the question of cetuximab as the only causative agent of ectropion, however, the authors discussed about the timing of ocular toxicity which, in their opinion, seemed to be unrelated to Cetuximab, also, is an EGFR inhibitor.…”

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confidence: 99%

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Erlotinib induced ectropion following papulopustular rash

Salman

Çerman

Seçkin

et al. 2015

J Dermatol Case Rep

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Background: Erlotinib is a targeted anti-cancer drug which acts through the inhibition of epidermal growth factor receptor (EGFR). Main observations:A 79-year-old developed bilateral ectropion after he received erlotinib treatment for lung adenocarcinoma. The ectropion completely resolved with symptomatic treatment without any modification in erlotinib therapy.Conclusions: EGFR inhibitors are frequently associated with a variety of mucocutaneous adverse events. Ocular toxicity associated with these agents has been reported rarely. We present this case to underline the importance of recognition of newly reported cutaneous and ocular adverse events of targeted therapies. (J Dermatol Case Rep. 2015; 9(2) IntroductionChemotherapeutic agents may be the cause of a wide spectrum of dermatological adverse events affecting the skin, skin appendages and mucous membranes. These adverse events are largely dependent on these agents' mechanism of action in cancer treatment. Recently developed targeted agents in cancer therapy are effective by acting on specific pathways and molecules and are therefore less frequently associated with systemic side effects compared with standard chemotherapy. Basal keratinocytes of the epidermis, hair follicles, sebaceous and eccrine epithelium, corneal, limbal and conjunctival epithelium are among the EGFR expressing cells and tissues. [1][2][3] The major functions of the EGFR in the skin are regulation of proliferation, differentiation, migration, apoptosis of cells and stimulation of keratinocyte migration and epidermal growth. 1 Therefore, despite their relative safety in terms of systemic toxicity, mucocutaneous side effects are seen rather frequently with EGFR inhibitors. Case reportA 79-year-old man presented with one-week-history of rash involving his face. He was on his second week of erlotinib treatment for lung adenocarcinoma. His past medical history was insignificant except for hypertension, vertigo and his medications included amlodipine and betahistine. Dermatological examination revealed monomorphic, erythematous papules and pustules over the centrofacial region. Based on the clinical findings, a diagnosis of erlotinib DOI: http://dx.doi.org/10.3315/jdcr.2015.1203 46 induced papulopustular rash was made. Treatment with hydrocortisone acetate cream twice daily for three days and sodium sulfacetamide lotion twice daily was commenced. After 3 weeks of treatment, his skin lesions completely resolved but he complained of recently developed burning sensation and dryness in his eyes. Bilateral ectropion of the lower eyelids were noted on physical examination and the patient was referred to ophthalmology department with a presumptive diagnosis of erlotinib induced ectropion (Fig. 1). Ophthalmological examination showed blepharitis, tear film dysfunction leading to dry eye and bilateral ectropion of the lower eyelids. As these findings were mild, no modification in erlotinib treatment was required and the ectropion ameliorated with symptomatic treatment in three weeks. The pati...

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Erlotinib induced ectropion following papulopustular rash

Salman

Çerman

Seçkin

et al. 2015

J Dermatol Case Rep

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“…21 Erlotinib has been associated rarely with increased tear break up time, 22 trichomegaly, 22,23 and a periorbital rash. 24 Besides receiving chemotherapy with vandetanib, our patient also had several conditions that may have predisposed her to developing abnormalities with corneal epithelial wound healing. Specifically, she had a history of EBMD with recurrent erosions and a history of external beam irradiation 15 months before her presentation.…”

Section: Case Reportmentioning

confidence: 97%

Corneal Verticillata After Dual Anti-Epidermal Growth Factor Receptor and Anti-Vascular Endothelial Growth Factor Receptor 2 Therapy (Vandetanib) for Anaplastic Astrocytoma

Yeh

Fine

Smith

2009

Cornea

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Vandetanib (ZD6474), a protein tyrosine kinase inhibitor with dual anti-EGFR and anti-vascular endothelial growth factor receptor 2 action, may have contributed to the formation of corneal verticillata in our patient. Inhibition of EGFR, which is involved with corneal epithelial cell migration and wound healing, may play a role in the pathogenesis underlying corneal vortex keratopathy and ocular surface conditions with significant epithelial turnover.

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“…reporting nonspecific conjunctivitis and dry eyes. There is one case report of bilateral periorbital rash leading to lower lid ectropion associated with erlotinib treatment (Methvin & Gausas, 2007).…”

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confidence: 99%