Abstract
4577 Background: Epiphora (E), excessive tearing (ET) due to insufficient drainage, is toxicity unique to 5FU or D. It is more common with q wk versus q 3 wk D (Esmaeli, Ophthalmology 2002). D is secreted in tears and causes inflammation and canalicular stenosis resulting in E, which can cause significant problems with reading, driving, and other activities as well as present the false impression of crying. While it has been reported mainly in pts with breast cancer, E has also been seen in other tumors treated with weekly D. Our preliminary experience in PC pts is presented. Methods: Pts with high-risk PC were treated with neoadjuvant D 35 mg/M2 and M 4 mg/M2 q wk x 3, with 1 wk off, for a total of 12 doses prior to radical prostatectomy. Pts who developed ET were instructed to use artificial tears; if symptoms (sx) did not improve, 1% prednisolone acetate eye drops were prescribed on the day before, the day of, and the day after chemotherapy. Results: Of 41 pts on protocol, 21 had ocular sx including blurry vision (1), eye irritation (1), ET (15), dry eyes (2–1 had ET later), photophobia (1), ingrown eyelashes (1), or infection of the upper eyelid (1). ET occurred at a median of 7.5 weeks (range 1–17) after starting chemotherapy. None of 6 pts treated with steroid eye drops improved and 1 with pre-existing glaucoma experienced an increase in intra-ocular pressure (IOP) requiring addition of a beta-blocker eye drop. In five pts who saw an ophthalmologist, ET was due to canalicular stenosis (2), ingrown eyelashes (1), “floppy eyelid syndrome”(1), normal (1). Conclusions: Weekly D and M can cause significant OT. Given these findings, baseline ophthalmologic evaluation and monthly follow-up are recommended. As weekly D administration is widespread and the impact of OT on quality of life can be significant, prophylactic use of artificial tears and/or steroid drops, and early intervention with silicone intubation of the canaliculi should be studied. Better documentation of the range and grading of OT due to D is needed. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis
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