Markedly Increased Ocular Side Effect Causing Severe Vision Deterioration After Chemotherapy Using New or Investigational Epidermal or Fibroblast Growth Factor Receptor Inhibitors.

Background To describe corneal epithelial changes after using epidermal (EGFR) or fibroblast growth factor receptor (FGFR) inhibitors as chemotherapy and to clarify incidence and prognosis. Materials Retrospective chart review. Results Among 6,871 patients and 17 EGFR or FGFR inhibitors, authors identified five EGFR inhibitors and two FGFR inhibitors that cause such corneal lesions. Unlike other old EGFR agents with rare ocular complications, Vandetanib, Osimertinib, and 3 EGFR agents under clinical trial (ABT-414, ASP5878, FPA144) caused vortex keratopathy in nine patients and ASP5878 and FPA144, the FGFR inhibitors of clinical trial caused epithelial changes resembling corneal dysmaturation in three patients. ABT-414 showed a remarkably short interval from the start of therapy to initiation of keratopathy. After excluding deceased patients, or were lost to follow-up or were still undergoing treatment, we confirmed the reversibility of corneal lesions after discontinuation of each agent. Although patients diagnosed with glioblastoma used prophylactic topical steroids before and during ABT-414 therapy, all developed vortex keratopathy. Conclusions EGFR and FGFR inhibitors are well known chemotherapy agents and could make corneal epithelial changes. Contrary to low probability of ocular complication with old EGFR drugs, recently introduced EGFR and FGFR agents showed high incidence of ocular complication with severe vision distortion. Doctors should forewarn patients planning chemotherapy with EGFR or FGFR inhibitors that decreased visual acuity could develop due to corneal epithelial changes, and also reassure them that the condition is reversible after the end of treatment without the use of steroid eye drops.