Limbal stem cell deficiency secondary to systemic daptopotamab deruxtecan (Dato-DXd): A case report and literature review

Purpose Limbal stem cell deficiency (LSCD) secondary to drug toxicity has been reported in topical and systemic chemotherapy. We report the first case of LSCD arising from a novel antibody-drug conjugate (ADC), Daptopotamab deruxtecan (Dato-DXd), in a patient with breast cancer. Case description A 66-year-old female with treatment-naïve breast cancer was enrolled in a clinical trial with regimen of Dato-DXd in combination with Durvalumab. She suffered from blurred vision, photophobia and ocular pain of both eyes after administration of the regimen for 5 months. Slit-lamp biomicroscopy with fluorescein staining revealed irregular epithelium at the upper 1/3 cornea. There was limited effect of topical steroid and lubricants, yet significant improvement after the cessation of Dato-DXd. The cornea resumed clear, and the best-corrected visual acuity were 20/20 in both eyes 6 months after discontinuation of Dato-DXd. Conclusion Early detection of the ocular adverse reaction and cessation of the causative drug can avoid permanent ocular morbidity and visual impairment.