- Design
- Prospective longitudinal cohort with corneal imaging
- Population
- 21 patients with HER2-positive breast cancer on HER2-targeted antibody-drug conjugates
- Primary outcome
- Ocular surface and corneal structural toxicity over treatment
- Effect
- Toxicity in 86% (18/21), mean onset 28 days; dose- and time-dependent, partially reversible
HER2-targeted antibody-drug conjugates are increasingly used in breast cancer, and the eye is a frequent site of off-target toxicity. This prospective study followed 21 patients on HER2-ADC therapy with detailed ocular surface and corneal imaging.
Ocular surface toxicity developed in 86% (18 of 21), at a mean of 28 days. The hallmark was a vortex-like keratopathy progressing from subepithelial microcysts to a whorl pattern, with confocal imaging showing corneal nerve fibre fragmentation and loss and reduced corneal sensitivity. The changes were dose- and time-dependent and partially reversible, with corneal clarity trending back toward normal after 12 cycles.
For anyone sharing care of these patients, the message is to expect ocular surface disease, set a baseline, and monitor. Lubrication and dose discussion with oncology — rather than stopping effective cancer therapy reflexively — are the usual response, since most changes recover.
- Prospective study of 21 patients on HER2-targeted antibody-drug conjugates.
- Ocular surface toxicity in 86% (18 of 21), at a mean of 28 days.
- Vortex-like keratopathy with corneal nerve loss and reduced corneal sensitivity.
- Changes were dose- and time-dependent and partially reversible over 12 cycles.
- Set a baseline ocular surface assessment and monitor patients starting these drugs.
Why it matters
It defines a common, recognisable and largely reversible toxicity, so eye symptoms need not trigger stopping an effective cancer drug.
Don't overread it
A small single-cohort study; it characterises the toxicity rather than comparing management strategies.
The statistics, in plain English
An 86% toxicity rate in a small prospective cohort shows the problem is common rather than rare; with 21 patients the exact rate is imprecise, but the consistent, reversible pattern is informative.
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