Abstract
BackgroundTo describe the first reported case of toxic optic neuropathy secondary to docetaxel (Taxotere®) chemotherapy.Case presentationA 53-year-old female presented with predominantly unilateral visual loss, but extensive bilateral visual field defects and bilateral optic nerve head swelling 2 weeks after first dose of docetaxel (Taxotere®) and trastuzumab (Herceptin®) chemotherapy for a left sided node-positive, HER2 positive breast cancer. Extensive investigation ruled out other causes of optic neuropathy. She was treated with high dose corticosteroids intravenously for 1 week then a tapering oral dose over 8 weeks. Visual field defects gradually resolved and visual acuity improved. Docetaxel chemotherapy was discontinued but targeted therapy with trastuzumab continued without further complication.ConclusionDocetaxel can cause a toxic optic neuropathy possibly due to an ischemic or neurotoxic mechanism at the optic nerve head. With cessation of docetaxel therapy and treatment with systemic corticosteroids, visual recovery can occur without significant residual visual deficit.
Highlights
To describe the first reported case of toxic optic neuropathy secondary to docetaxel (Taxotere®) chemotherapy.Case presentation: A 53-year-old female presented with predominantly unilateral visual loss, but extensive bilateral visual field defects and bilateral optic nerve head swelling 2 weeks after first dose of docetaxel (Taxotere®) and trastuzumab (Herceptin®) chemotherapy for a left sided node-positive, HER2 positive breast cancer
We describe the first reported case of toxic optic neuropathy caused by docetaxel chemotherapy and discuss its significance in the context of previous hypothesized mechanisms of optic nerve damage caused by taxanes
Wang and Sadun recently proposed 5 postulates required for establishing a causal link between a toxic agent and an optic neuropathy [15]
Summary
Wang and Sadun recently proposed 5 postulates required for establishing a causal link between a toxic agent and an optic neuropathy [15]. There is limited literature linking docetaxel to optic nerve dysfunction, the other major taxane, paclitaxel, has been previously reported to cause optic nerve dysfunction on both electroretinography and visual-evoked potential testing [17] These optic nerve changes were reported in patients who experienced scintillation scotoma and photopsias mainly during paclitaxel infusion [18,19,20]. Other studies have linked this symptomatology to electrophysiological changes in the retina and optic nerve [10,17,21] with Scaioli et al [17] proposing that these changes could be caused by vascular dysregulation and potentially vasospasm in retinal and optic nerve vasculature This vascular hypothesis could be supported by the clinical appearance of optic nerve head swelling/haemorrhages in our patient that was consistent with a non-arteritic acute ischemic optic neuropathy. Received: 21 November 2013 Accepted: 17 February 2014 Published: 24 February 2014
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
