Epiphora and Canalicular Stenosis Associated With Adjuvant Docetaxel in Early Breast Cancer: Is Excessive Tearing Clinically Important?

Docetaxel, as a single agent or in combination, is widely used in the palliative treatment of many common solid tumors, including breast, lung, and prostate cancers. Docetaxel is also used in many of the adjuvant regimens in early breast cancer, including the docetaxel, carboplatin, and trastuzumab regimen, the docetaxel and cyclophosphamide combination, and those with or without an anthracycline or trastuzumab (docetaxel/doxorubicin/cyclophosphamide, fluorouracil/epirubicin/cyclophosphamide followed by docetaxel, doxorubicin/cyclophosphamide followed by docetaxel, and doxorubicin/cyclophosphamide followed by docetaxel plus trastuzumab). Adjuvant-based docetaxel may lead to well-known acute and chronic adverse events including neutropenic fever or infection, stomatitis, hypersensitive reaction, rash, fluid retention, peripheral neuropathy, and fatigue. The safety profile of docetaxel is schedule and dose dependent. Excessive tearing (epiphora) is a common adverse event reported in patients who receive docetaxel for metastatic disease. 1-10 However, there is little published information about ocular toxicity, including epiphora, in the adjuvant setting. Two large docetaxel-based adjuvant phase III studies briefly reported docetaxel-related ocular toxicity. In the Breast Cancer International Research Group (BCIRG) trial 001, lacrimal disorder was reported in 11.3% versus 7.1% of patients who received TAC versus those who received fluorouracil/doxorubicin/ cyclophosphamide, respectively. 11 In the Eastern Cooperative Oncology Group study 1199, grade 3 and 4 lacrimation was reported in 5% of patients who received weekly adjuvant docetaxel versus less than 1% of patients who received adjuvant paclitaxel once per week, paclitaxel once every 3 weeks, or docetaxel once every 3 weeks. Other ocular symptoms such as conjunctivitis were also reported in less than 1% in patients in this trial, including those who received docetaxel once per week. n the article that accompanies this editorial, Chan et al 13 studied the prevalence of epiphora, canalicular stenosis, and nasolacrimal duct obstruction in patients with early-stage breast carcinoma who received adjuvant docetaxel-based combination chemotherapy. This is a large prospective report evaluating ocular toxicity in patients with early breast cancer receiving adjuvant therapy, although several previous studies have reported the association between docetaxel and epiphora and its anatomic correlates, canalic-