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Published on: June 26, 2019
Bilateral keratitis associated with afatinib therapy
Ya-Tung Liu1, Chen-Wei Lin1, Chi-Chin Sun2,3
1Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Abstract:
This case discussed a significant ocular side effect, bilateral keratitis, which could be induced by afatinib, an irreversible epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). We explored the disease progression of a 52-year-old, stage IV nasopharyngeal carcinoma male patient, who was under afatinib treatment and had experienced progressive bilateral eye dryness and tenderness on increasing afatinib from 40 mg every other day to 40 mg daily. Clinical examination noted bilateral visual acuity reduction, diffuse superficial punctate keratopathy in the right eye, and a central epithelial defect in the left eye. Seidel test results were negative for both eyes, with no corneal infiltration, lagophthalmos, anterior chamber cell precipitation, or retinal lesion. Symptoms subsequently resolved after reducing the frequency of afatinib used, along with intensive ocular hydration. In summary, this case highlighted afatinib's potential link to bilateral keratitis, and early afatinib dose adjustment with supportive medication could significantly reverse the condition.
Insights
Afatinib, an EGFR-TKI, may cause bilateral keratitis. Adjusting the afatinib dose and using eye drops can resolve this ocular side effect.
Area of Science:
- Oncology
- Ophthalmology
- Pharmacology
Background:
- Afatinib is an irreversible epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) used in cancer treatment.
- Nasopharyngeal carcinoma (NPC) is a type of head and neck cancer.
- Ocular side effects are potential complications of EGFR-TKI therapy.
Observation:
- A 52-year-old male patient with stage IV NPC developed bilateral eye dryness and tenderness.
- Symptoms worsened with increased afatinib dosage from 40 mg every other day to 40 mg daily.
- Clinical examination revealed reduced visual acuity, punctate keratopathy, and a corneal epithelial defect.
Findings:
- The patient's condition was diagnosed as bilateral keratitis potentially induced by afatinib.
- Seidel tests were negative, and no signs of infection or other severe ocular complications were observed.
- Reducing afatinib dosage and implementing intensive ocular hydration led to symptom resolution.
Implications:
- This case highlights a potential link between afatinib and bilateral keratitis.
- Early dose adjustment of afatinib and supportive ocular care can effectively manage this side effect.
- Awareness among clinicians is crucial for prompt diagnosis and management of afatinib-induced ocular toxicity.
