Corneal Toxicities Related With Antibody-Drug Conjugates In Gynecologic Cancer

The use of new drugs for the treatment of cancer has produced new toxicities.
ADCs consist of a highly selective monoclonal antibody for a tumor-associated antigen and a potent cytotoxic payload
conjugated through a linker.
The purpose of this study is to report the clinical features and outcomes of corneal toxicity following ADCs

Retrospective study in a reference hospital in Madrid

15 patients with advanced gynecologic cancer have been evaluated in our hospital undergoing a clinical trials with antibody-drug conjugates (ADCs), to assess ocular toxicity through complete ophthalmological examinations in each treatment cycle, during a period of 30 months between 2021 and 2024.

Both eyes were involved in each case and all patients complained of blurred vision , ocular pain ,foreign-body sensation  and photophobia .

Slit-lamp examination demonstrated fine corneal subepithelial opacities (microcyst-like epithelial keratopathy ), mainly involving the corneal periphery migrating to the center ,with a ring appearance and a clear central cornea at  the bigning , modifying the curvature and refractive situation.

In all patients, the cornea cleared, and visual acuity recovered  withen  2-3  weeks, with a short course of topical steroids and lubricants.
3  patients have had Vortex keratopathy- like.

In some cases,  ADCs dose modification  was necessary 

Corneal complications due to new targeted cancer therapies are important,they appear to be transient, but may persist during treatment.
Current preventive therapies demonstrate limited efficacy at mitigating pseudomicrocysts and other ocular surface AEs.
Management of ocular AEs requires a multidisciplinary approach to minimize treatment discontinuation and optimize
clinical outcomes.