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Prevention of Docetaxel Induced Dacryostenosis

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00266838
Recruitment Status : Completed
First Posted : December 19, 2005
Last Update Posted : June 28, 2010
Information provided by:
Universitaire Ziekenhuizen Leuven

Brief Summary:

The antineoplastic agent Docetaxel (Taxotere®) is approved for the treatment of patients with metastatic and locally advanced breast cancer and other malignancies. There are 2 frequently used schedules of treatment with Docetaxel. Docetaxel can be administered every 3 weeks or in a weekly regimen. The efficacy seems to be similar but the toxicity profile changes. In the standard 3-weekly Docetaxel regimen the dose-limiting side effect is myelosuppression, while in the weekly regimen there is only a mild myelosuppression. On the other hand, weekly Docetaxel has a side effect that is rare in the 3-weekly schedule: epiphora (= tearing eye) caused by dacryostenosis.

The underlying mechanism of dacryostenosis induced by weekly Docetaxel is fibrosis of the lacrimal puncta and canaliculi. Docetaxel has been reported to be secreted in the lacrimal tears. Direct contact between Docetaxel containing tears and the epithelial lining causes chronic inflammation of the mucosa and ultimately fibrosis of the most narrow part of the lacrimal outflow system i.e. the lacrimal puncta and canaliculi.

A surgical treatment is possible for dacryostenosis. In case of subtotal stenosis of the lacrimal canaliculi, silicone intubation of the canaliculi is performed in order to prevent further closure. In the case of complete stenosis, placement of a permanent pyrex glass tube of Jones is required.

To our knowledge, there is no primary prevention for Docetaxel induced dacryostenosis.

The rationale of this randomized double blind interventional study is to investigate the efficacy of corticosteroid versus artificial tears topical eye treatment in patients on a weekly Docetaxel regimen in prevention of dacryostenosis. The dacryotoxic agent Docetaxel in the lacrimal tears will be washed away by the repetitive use of eye drops. In addition, eye drops containing corticosteroids have an anti-inflammatory effect and may further prevent the formation of fibrosis.

A new treatment protocol will be investigated. Two different commercially available eye drops will be compared: dexamethasone sodium phosphate (Maxidex®, Alcon) in one eye of the patient and artificial tears (Lacrystat®, Viatris) in the other eye of the same patient. The study period will start with topical eye treatment from day 1 of cycle 1 and will continue during the administration of chemotherapy, with a final analysis at 26 weeks.

Condition or disease Intervention/treatment Phase
Epiphora Drug: Maxidex; Lacrystat Phase 1

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single (Investigator)
Primary Purpose: Prevention
Official Title: A Double Blind Interventional Study of the Efficacy of Topical Eye Treatment in the Prevention of Docetaxel Induced Dacryostenosis
Study Start Date : July 2006
Actual Primary Completion Date : May 2008
Actual Study Completion Date : May 2009

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Placebo Comparator: Lacrystat
Drug: Maxidex; Lacrystat
6 times daily, for 20 weeks.

Active Comparator: Maxidex
Applying Maxidex
Drug: Maxidex; Lacrystat
6 times daily, for 20 weeks.

Primary Outcome Measures :
  1. Incidence of dacryostenosis [ Time Frame: 20 weeks ]
  2. Grading of dacryostenosis [ Time Frame: 20 weeks ]

Secondary Outcome Measures :
  1. Correlation Docetaxel in lacrimal tear and dacryostenosis [ Time Frame: 20 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with locally advanced or metastatic breast cancer receiving weekly Docetaxel chemotherapy with rest weeks in between at regular time intervals. The timing of rest weeks between cycles is not restricted. Examples of allowed regimens are Docetaxel 36 mg/m2 day 1 and 8 every 3 weeks; day 1, 8, 15 every 4 weeks; day 1, 8, 15, 21, 28, 35, 42, 49 every 10 weeks. Dosing and rest weeks can be further modified depending on the clinical situation, but dose intensity should be at least 60 mg/m2 every 3 weeks during the 9 week treatments for eligibility. Combination with other chemotherapy (such as capecitabine) is allowed.
  • Capability to administer eye drops (either by patient or companion).
  • Written informed consent.
  • Age > 18 y

Exclusion Criteria:

  • Systemic criteria:

    • Previous administration of Docetaxel.
    • Pregnancy.
  • Eye criteria:

    • Ocular surface, corneal, conjunctival or eyelid disease.
    • Soft contact lens wearing
    • Glaucoma
  • Lacrimal criteria:

    • Hypersecretion of tears: ocular surface, corneal, conjunctival or eyelid disease.
    • Functional blockage of lacrimal drainage without anatomical obstruction (facial nerve palsy, displacement of the lower lacrimal punctum from the lacrimal lake, involutional lower eyelid laxity).
    • Anatomical obstruction of lacrimal drainage system:

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00266838

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Leuven, Belgium, 3000
Sponsors and Collaborators
Universitaire Ziekenhuizen Leuven
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Principal Investigator: Ilse Mombaerts, MD, PhD Universitaire Ziekenhuizen Leuven
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Responsible Party: Ilse Mombaerts, UZLeuven Identifier: NCT00266838    
Other Study ID Numbers: UZL OFT-ML 3386
First Posted: December 19, 2005    Key Record Dates
Last Update Posted: June 28, 2010
Last Verified: December 2005
Keywords provided by Universitaire Ziekenhuizen Leuven:
Lacrimal Obstruction
Additional relevant MeSH terms:
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Lacrimal Apparatus Diseases
Eye Diseases
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents