Ocular adverse events of perioperative adjuvant docetaxel vs paclitaxel for breast cancer: propensity-score overlap-weighted analysis.

Background: Taxanes are known to be associated with several ocular adverse events; however, large-scale data comparing the risk of ocular adverse events between the two commonly used taxanes, docetaxel (DTX) and paclitaxel (PTX), remain limited. Therefore, we aimed to compare the risks of epiphora, cystoid macular edema, and optic neuropathy between DTX- and PTX-based chemotherapy regimens.

Methods: Using a nationwide claims database in Japan, we identified 6038 patients who initiated neoadjuvant or adjuvant taxane-based chemotherapy for breast cancer between April 2014 and November 2022. Data analysis was conducted in 2024. This study was conducted across multiple referral centers and community hospitals in Japan, providing a comprehensive view of taxane-based chemotherapy practices in diverse healthcare settings. Participants included 6038 patients diagnosed with breast cancer who initiated neoadjuvant or adjuvant taxane-based chemotherapy. Eligibility criteria included female patients aged 18 years or older. Participants were selected from a nationwide claims database using a consecutive sampling method. Patients who received DTX-based chemotherapy (DTX group) were compared with those who received PTX-based chemotherapy (PTX group). After adjusting for potential confounders using a propensity score-overlap weighting method, we estimated the incidence of the three ocular adverse events and hazard ratios (HRs) using Cox proportional hazards regression models.

Results: Among the 6038 eligible patients, 3829 were in the DTX group and 2209 in the PTX group. The adjusted HR for epiphora in the DTX group was 1.69 [95% confidence interval (CI), 1.17 to 2.45] compared with the PTX group. For cystoid macular edema and optic neuropathy, the adjusted HRs were 0.74 (95% CI, 0.52 to 1.04) and 0.72 (0.47 to 1.11), respectively. The composite incidence of epiphora, cystoid macular edema, and optic neuropathy did not differ significantly between the DTX and PTX groups.

Conclusion: Among patients receiving taxane-based chemotherapy for breast cancer, DTX was associated with a higher risk of epiphora compared with PTX. However, the incidence rates of cystoid macular edema and optic neuropathy did not differ significantly between the two groups. These findings offer valuable insights into the ocular adverse event profile of taxane-based chemotherapy in patients with breast cancer.