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Ulcerative keratitis in gastrointestinal stromal tumor patients treated with perifosine

Debraj Shome1, Jonathan Trent, Ladan Espandar

  • 1Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

Ophthalmology
|January 19, 2008
PubMed
Abstract

Insights

A novel cancer drug, perifosine, may cause vision-threatening ulcerative keratitis in patients with advanced gastrointestinal stromal tumors (GIST). Early detection and treatment with steroids and lubrication can help reverse vision loss.

Area of Science:

  • Oncology
  • Ophthalmology
  • Pharmacology

Background:

  • Perifosine is an alkylphospholipid with antiproliferative effects via protein kinase B inhibition.
  • Gastrointestinal stromal tumors (GIST) are often treated with imatinib, but resistance can develop.

Observation:

  • Five patients with metastatic GIST receiving combination therapy of imatinib and perifosine developed ulcerative keratitis.
  • Ocular symptoms included redness, irritation, photophobia, and decreased vision, with corneal infiltration observed on slit-lamp biomicroscopy.

Findings:

  • The ulcerative keratitis presented as a peripheral, paralimbal, ring-shaped, superficial corneal stromal infiltration.
  • This condition, graded as National Cancer Institute grade II, responded significantly to topical steroids, antibiotics, and lubrication, particularly when steroids were used early.

Implications:

  • Perifosine, especially in combination with imatinib, may cause significant ocular toxicity.
  • Prompt diagnosis and early intervention with topical steroids and lubrication are crucial for potentially reversing vision loss associated with this drug-induced keratitis.

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