Ribociclib-associated vortex keratopathy

SD-OCT Imaging of Macular Changes in Fabry Disease: A Case Report

Fabry disease (FD) is a rare, X-linked lysosomal storage disorder that can result in fatal end-stage renal disease, heart failure, and cerebro-occlusive events. Vague clinical symptoms and rarity often mean diagnosis and potential treatment is delayed. Ophthalmic findings in FD patients can be helpful in establishing an early diagnosis and timely treatment. Spectral domain optical coherence tomography (SD-OCT) imaging in FD patients shows hyper-reflective foci (HRF) in characteristic patterns within the inner retinal layers. We found that the HRF was localised in linear distributions at the deep and superficial borders of the retinal inner nuclear layer, likely reflecting anatomic vascular plexuses and FD-related sphingolipid deposition within the vessel walls. These results highlight the potential use of SD-OCT in FD and how it may aid diagnosis in undifferentiated patients, prognostication, and disease monitoring.

Vortex keratopathy associated with ribociclib

INTRODUCTION

Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors are the new generation drugs that have been started to be used in our clinical practice recently. These drugs have been shown to have better progression-free survival compared to standard therapy in patients with hormone receptor-positive (HR) and human epidermal growth factor receptor 2 (HER-2)-negative breast cancer. The most common side effects of CDK 4-6 inhibitors are neutropenia, nausea, leukopenia, fatigue, and diarrhea. This case demonstrated vortex keratopathy in both eyes, a rare condition in patients with breast cancer treated with ribociclib.

CASE REPORT

A 68-year-old female patient was diagnosed with locally advanced HR (+)/HER2 (-) breast cancer in March 2015. In June 2021, bone metastases were detected. The patient was started on ribociclib and fulvestrant. After three cycles of ribociclib and fulvestrant treatment, she was admitted with the complaint of blurred vision in her left eye. Slit-lamp biomicroscopy examination revealed subepithelial haze with central subepithelial whorls in both corneas, more in the left eye, and also a mild punctate epithelial staining was observed with the application of fluorescein dye.

MANAGEMENT AND OUTCOME

Ribociclib treatment was immediately discontinued and no changes were observed in the cornea and vision levels during the one-month follow-up.

DISCUSSION

Routine and regular follow-up eye examinations in breast cancer patients treated with ribociclib may benefit patients in our daily clinical practice and may help us to detect side effects at an early stage and to manage them more effectively.

Cyclin-Dependent Kinase 4 and 6 Inhibitors: A Quantum Leap in the Treatment of Advanced Breast Cancers

Breast cancer (BC) is defined as an uncontrolled growth of breast cells that affected 2.3 million women in 2020 alone. Until a few years earlier, radiotherapy and chemotherapy were the most commonly used treatments in treating BC; however, many trials and studies were conducted to test the competence of cyclin-dependent kinases 4/6 (CDK4/6) in arresting the cell cycle, and it was found that they were highly influential in halting the disease from progressing. Palbociclib, ribociclib, and abemaciclib are the three drugs that have been approved by the US Food and Drug Administration (FDA) and are even more efficient when used in combination with aromatase inhibitors and fulvestrant. This article aimed to explain the effect of CDK4/6 inhibitors on tumor cells and their efficacy in combination with other drugs. We further explored the development of resistance to these treatments and future possibilities.

Targeting kinases with thymoquinone: a molecular approach to cancer therapeutics

Kinases are enzymes that are important for cellular functions, but their overexpression has strong connections with carcinogenesis, rendering them important targets for anticancer drugs. Thymoquinone (TQ) is a natural compound with proven anticancer activities, at least in preclinical studies. TQ can target several kinases, including phosphoinositide 3-kinase (PI3K), mitogen-activated protein kinase (MAPK), Janus kinase/signal transducers and activators of transcription (JAK/STAT), polo-like kinase 1 (PLK1), and tyrosine kinase in different cancer cells and animal models. Inhibiting the activity of kinases or suppressing their expression might be among the mechanisms of TQ anticancer activity. In this review, we discuss the role of TQ in kinase regulation in different cancer models.