EGFR Inhibitors for Lung Cancer Tied to Increased Keratitis Risk

— Findings do not inform us to stop these drugs, scientist states, however ought to direct scientific choices

by
Randy DotingaContributing Writer, MedPage Today
January 13, 2024

Clients with lung cancer treated with skin development aspect receptor (EGFR) inhibitors might have an increased danger of new-onset keratitis, a U.S. population-based associate research study revealed.

Over a 20-year duration, 1.12% of clients who were treated with EGFR inhibitors established new-onset keratitis compared to 0.74% of those who did not take these drugs (HR 1.520, 95% CI 1.339-1.725), reported Kevin Sheng-Kai Ma, DDS, of Harvard T.H. Chan School of Public Health in Boston, and associates in JAMA Ophthalmology

Particularly, clients treated with EGFR inhibitors– consisting of gefitinib (Iressa), erlotinib (Tarceva), afatinib (Gilotrif), and osimertinib (Tagrisso)– had greater threats of keratoconjunctivitis (HR 1.367, 95% CI 1.158-1.615), shallow keratitis (HR 1.635, 95% CI 1.306-2.047), and corneal ulcer (HR 2.132, 95% CI 1.515-3.002).

Significantly, clients taking the second-generation EGFR inhibitor afatinib had the greatest danger of keratitis (HR 2.229, 95% CI 1.480-3.356), though the threat was still observed with osimertinib, the basic first-line alternative in the metastatic setting (HR 1.591, 95% CI 1.130-2.239).

Ma informed MedPage Today that clinicians need to bear in mind that the drugs can considerably enhance the total survival of lung cancer clients. The findings “do not inform us to stop EGFR inhibitors,” he stated, “however would assist our medical choices in regards to whether we must follow the clients more often if the clients have actually revealed early indications of extreme types of keratitis.”

According to the Cleveland Cliniccontact lenses are a significant threat element for keratitis, and other threat aspects consist of damaged resistance and long-lasting usage of corticosteroids. Eye drops are at first recommended, and corneal transplants might be required in the most serious cases.

Jeanine Baqai, MD, of Northwestern University Feinberg School of Medicine in Chicago, informed MedPage Today that optometrist see keratitis typically.

“It is necessary to figure out if the reason for this swelling is contagious or non-infectious,” she stated. “If there is issue for infection, we will generally culture the client and begin them on antimicrobial treatment. The infection might be bacterial, viral, fungal, or parasitic. If the swelling is not felt to be contagious and there is no ulcer, we might treat with steroids. We are lucky to be able to fix most keratitis with topical treatment.”

EGFR inhibitors are utilized to deal with numerous sort of cancers consisting of lung, breast, colorectal, and pancreatic cancer. Case reports and series have actually reported ocular unfavorable impacts in clients taking the drugs for lung cancer, Ma kept in mind, however no extensive research studies have actually taken a look at the general threat or stratified the outcomes by kind of drug and kind of keratitis.

There are 3 generations of the drugs offered, Ma stated, and a 4th is under advancement. The danger stayed constant over the 20-year duration of the research study, recommending that the development of the drugs with time has actually not altered the danger level.

The drugs might improve the danger of keratitis by preventing recovery within the cornea, Ma described. “All clients taking all those drugs ought to be advised by their eye doctor, medical oncologist, or medical care doctors about the possible problems from EGFR-targeted treatments.”

Baqai stated the link in between the drugs and keratitis “is definitely understood among cornea subspecialists, however it is not a problem we normally see regularly like other conditions.” “as more drugs surface area, the occurrence with which we see these clients boosts.”

“Cancer clients and clients getting these medications ought to be taken a look at and assessed with a really critical eye,” she included. “Sometimes we can see adverse effects from medications and other times we can see symptoms connected to the cancer itself. It is essential to be really thoughtful about the cause and the treatment of any keratitis, because the condition can cause loss of vision. Expedited recommendation to the proper subspecialist is constantly suggested.”

For this research study, Ma and group took a look at information from the TriNetX database on 1,388,108 adult clients who were dealt with for lung cancer from May 2003 through October 2023. The index dates were the date of very first prescription for the clients who took the EGFR inhibitors or the date of medical diagnosis with lung cancer for the clients who did not take these drugs.

Of the overall clients, 22,225 got EGFR inhibitors. Mean age was 69.7, and 62.8% were females. About half of clients in both groups had hypertensive illness; those taking EGFR inhibitors were most likely to have secondary deadly neoplasms.

What’s next? Ma stated his group is dealing with follow-up research studies to take a look at the danger of keratitis by ethnic background, considering that research study has actually connected ethnic background to EGFR anomaly status.