Lacrimal drainage system stenosis associated with Trastuzumab emtansine (Kadcyla®, T-DM1) administration: a case report

• Published in: BMC cancer 2019-08, Vol.19 (1), p.774-774, Article 774
• Main Authors: Kim, Chung Young, Kim, Namju, Choung, Ho-Kyung, In Khwarg, Sang
• Format: Article
• Language: English
• Subjects: Ado-Trastuzumab Emtansine - administration & dosage; Ado-Trastuzumab Emtansine - adverse effects; Adult; Antibacterial agents; Antibodies; Antibody-drug conjugates; Antineoplastic agents; Antineoplastic Agents, Immunological - administration & dosage; Antineoplastic Agents, Immunological - adverse effects; Biological products; Breast cancer; Breast Neoplasms - complications; Breast Neoplasms - diagnosis; Breast Neoplasms - drug therapy; Cancer; Cancer metastasis; Cancer treatment; Case Report; Case studies; Complications and side effects; Constriction, Pathologic; Dexamethasone; Diagnostic Imaging; Dosage and administration; Drug therapy; Epidermal growth factors; Epiphora; Female; Fluorescein; Glucocorticoids; Humans; Kadcyla; Lacrimal Apparatus Diseases - diagnosis; Lacrimal Apparatus Diseases - etiology; Lapatinib; Liver; Liver cancer; Nasolacrimal duct stenosis; Patient outcomes; Stenosis; Surgery; Tobramycin; Tomography, Optical Coherence; Trastuzumab; Trastuzumab emtansine
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-5986-5

Trastuzumab emtansine (Kadcyla®, T-DM1) is an antibody-drug conjugate used to treat HER2 (human epidermal growth factor receptor 2) overexpressing metastatic breast cancer. In this report, we present the first case of lacrimal drainage system stenosis identified after T-DM1 administration, and its successful treatment with a topical steroid. A 36-year-old female with metastatic breast cancer was referred for excessive tearing of both eyes. She previously underwent mastectomy and was treated with multiple anti-cancer regimens. However, metastases to liver and bone were identified and T-DM1 was administered. After 2 months, epiphora developed in both eyes and the patient was referred for ophthalmologic examination. The height of the tear meniscus was increased. The fluorescein dye disappearance test (FDDT) showed a delayed clearance in both eyes. Diagnostic lacrimal probing demonstrated a lower distal canalicular stenosis in both eyes. Dacryocystography indicated multiple focal narrowing of nasolacrimal duct in the right eye and diffused narrowing of nasolacrimal duct in the left eye. Topical eyedrop of tobramycin 0.3% and dexamethasone 0.1% were prescribed four times a day. After 2 months of treatment, the patient reported relief from epiphora, and the height of tear meniscus was normalized in both eyes. T-DM1 administration in breast cancer treatment can induce lacrimal drainage system stenosis, which can be treated effectively with a topical steroid.