Ocular Surface Adverse Events of Systemic Inhibitors of the Epidermal Growth Factor Receptor (EGFRi): a Prospective Trial.

Abstract

Purpose : Controversy exists regarding the safety of agents that systemically inhibits epidermal growth factor receptor (EGFRi) in the ocular surface for oncologic patients. We performed a prospective observational clinical study to compare the ocular surface toxicity of systemic EGFRi between a case group and a control group without EGFRi.

Methods : Patients with lung or colon cancer (34 lung and 18 colorectal adenocarcinoma) were divided in two groups: 26 patients treated with systemic EGFRi wether erlotinib for lung cancer or panitumumab for colon cancer (18 lung and 8 colon cancer,mean age 73.4+/-7.3 years old) and 26 patients in a control group without EGFRi treatment matched by the stage of the disease (16 lung and 10 colon cancer, mean age 63.5+/-8.6 years old). Patients in both groups patients were chemotherapy naive (de novo treatment).Four visits were scheduled in a one year period comparing signs and symptoms in terms of symptom questionnaires ( SIDEQ, OSDI and AVS), corneal fluorescein staining ( Oxford test), tear production (Shirmer's test),and a quantitative evaluation of conjunctival chemosis and hyperemia. Basal epithelial cell density (BECD) and corneal subepithelial nerve fiber density (SNFD) were measured and compared using confocal microscopy (Heidelberg Ingeneering, Germany). The differences in each variable between the 2 groups were compared with the analysis of variance( ANOVA) (quantitative variables).P value <0.05 was considered significant for all comparisons.

Results : Statistically significant differences were found between patients under EGFRi and the age-matched controls in terms of conjunctival chemosis and Oxford test in all visits (P< 0.05). When cases and controls were evaluated separatedly, the case group showed a significant worse evolution in symptoms (SIDEQ and OSDI), Oxford test and Shirmer's test (all P <0.05). However the control group did not show significant differences among visits. We did not find significant differences in terms of ECD and SNFD between cases and age/type of cancer matched controls.

Conclusions : Systemic EGFRi may increase conjunctival chemosis and corneal fluorescein staining. Oncologic patients treated with EGFR should be monitored closely with ophthalmologic examinations to detect dry eye

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.