Neoadjuvant Chemotherapy Alone or Combined with EGFR-Directed Targeted Therapy or Anti-PD-1 Immunotherapy for Locally Advanced Lacrimal Sac and Nasolacrimal Duct Carcinomas

Authors

Jeremy Goldfarb
Janet Fan
Luana Guimaraes de Sousa
Neal Akhave
Jeffrey Myers
Ryan Goepfert
Krish Manisundaram
Jiawei Zhao
Steven J Frank
Amy Moreno
Renata Ferrarotto
Bita Esmaeli

Language

English

Publication Date

3-18-2024

Journal

Seminars in Ophthalmology

DOI

10.1080/08820538.2024.2324057

PMID

38500295

PMCID

PMC11408703

PubMedCentral® Posted Date

3-18-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background/aims: We describe our findings in patients with locally advanced lacrimal sac and nasolacrimal duct (NLD) carcinoma who received neoadjuvant systemic therapy.

Methods: We identified patients with locally advanced primary lacrimal sac/NLD carcinoma treated with neoadjuvant systemic intravenous therapy at our institution during 2017-2019.

Results: The study included seven patients, four men and three women; the mean age was 60.4 years (range: 43-76). All patients had locally advanced disease with significant orbital soft tissue invasion with or without skull base invasion making eye-sparing surgery not feasible as an initial step. Three patients had poorly differentiated squamous cell carcinoma; two, invasive carcinoma with basaloid and squamous features; one, high-grade carcinoma with features suggestive of sebaceous differentiation; and one, undifferentiated carcinoma. The neoadjuvant regimens were cisplatin and docetaxel (n = 1); carboplatin and docetaxel (n = 1); paclitaxel and cetuximab (n = 1); carboplatin, paclitaxel, and cetuximab (EGFR inhibitor) (n = 2); cisplatin, docetaxel, and pembrolizumab (anti-PD-1 immunotherapy) (n = 1); and carboplatin, paclitaxel, and pembrolizumab (n = 1). All patients had radiologic disease regression, and one patient had radiologic near-complete response. After neoadjuvant therapy, all patients underwent wide local excision and adjuvant concurrent chemoradiation. Two patients had a complete pathologic response. At a median follow-up period of 13 months after chemoradiation (range, 8-54 months), all patients were alive without evidence of disease. One patient had nodal metastasis treated with lymph node dissection and adjuvant chemoradiation.

Conclusions: Neoadjuvant systemic therapy can shrink tumors in patients with locally advanced primary lacrimal sac/NLD carcinoma with orbital or skull base invasion.

Keywords

Cetuximab, immune checkpoint inhibitors, lacrimal sac carcinoma, neoadjuvant therapy, pembrolizumab

Published Open-Access

yes

Recommended Citation

Goldfarb, Jeremy; Fan, Janet; de Sousa, Luana Guimaraes; et al., "Neoadjuvant Chemotherapy Alone or Combined with EGFR-Directed Targeted Therapy or Anti-PD-1 Immunotherapy for Locally Advanced Lacrimal Sac and Nasolacrimal Duct Carcinomas" (2024). Faculty, Staff and Student Publications. 4847.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4847