Pemetrexed-Associated Eyelid Edema: Effective Treatment by Excision of Lymphedematous Eyelid Tissue

Our plain-English summary of Pemetrexed-Associated Eyelid Edema: Effective Treatment by Excision of Lymphedematous Eyelid Tissue, by N. Mangla, A. Carlson, A. Wakil, et al (Ophthalmic Plastic and Reconstructive Surgery, 2015).

The study

• Authors: N. Mangla, A. Carlson, A. Wakil, N. Wu, E.J. Wladis
• Journal: Ophthalmic Plastic and Reconstructive Surgery
• Published: 2015;31(6):e155-7
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pemetrexed is an antimetabolite agent that inhibits multiple folate-requiring enzymes and is used in the treatment of mesothelioma and non-small-cell lung cancer. One of its toxicities is isolated cutaneous swelling affecting the eyelids and/or orbit. The pathologic assessment or its management has not been addressed to date. Herein, the authors report a case of a 77-year-old woman treated with pemetrexed for non-small-cell lung adenocarcinoma who developed persistent, severe bilateral lower eyelid swelling for several months, despite compresses and oral diphenhydramine. Elective excision was performed with good results and no recurrence after 6 months' follow up. Histopathologically, the excised tissue showed changes typical of dermatochalasis with dissolution of collagen and elastic bundles and marked dilation of lymphatic vessels. The combination of pre-existing, localized lymphatic failure and capillary leakage secondary to pemetrexed therapy can explain the onset and worsening swelling with successive rounds of chemotherapy.

In plain English

This article was a case report about a side effect of pemetrexed. The authors note that this chemotherapy drug is used for mesothelioma and non-small-cell lung cancer. The patient was a 77-year-old woman treated for non-small-cell lung adenocarcinoma, not mesothelioma, and the article does not mention asbestos. Two days after the last course of pemetrexed, the patient developed severe swelling of both lower eyelids. The swelling lasted several months, did not respond to compresses or oral diphenhydramine, and interfered with wearing eyeglasses. Tests found no other cause, so the swelling was believed to be due to the drug. Surgeons removed the swollen tissue. Under the microscope it showed fluid in the skin, widely separated collagen bundles and dilated lymph vessels, similar to dermatochalasis (loose, baggy eyelid skin). Four months after surgery the swelling had resolved and the patient could wear eyeglasses. The authors also listed this case alongside nine previously published ones. They concluded that pre-existing dermatochalasis combined with fluid leakage linked to pemetrexed may explain the swelling, and that surgery is an appropriate treatment.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a table summarizing previously published case reports
• Who was studied: One 77-year-old woman with non-small-cell lung adenocarcinoma, treated at Albany Medical College / Albany, New York, U.S.A.
• Exposure: The chemotherapy drug pemetrexed (Alimta), given first line; the table lists 5 cycles at onset of the swelling. No asbestos exposure is described.
• Main results:
  • The patient developed severe bilateral lower eyelid swelling, National Cancer Institute grade II, lasting several months and not relieved by compresses or oral diphenhydramine.
  • No other cause was found, and the swelling was attributed to pemetrexed.
  • The removed eyelid tissue showed swelling of the skin layer, widely separated collagen bundles and dilated lymph vessels, similar to dermatochalasis.
  • Four months after surgery, the patient's swelling had resolved and the patient could wear eyeglasses.
  • In the authors' table of 10 reported cases, including this one, 7 occurred before chemotherapy cycle 7.
• The authors' conclusion: The authors concluded that pre-existing dermatochalasis may impair lymph drainage of the lower eyelid, that capillary protein leakage then causes fluid to build up, and that surgery is an appropriate treatment for patients who develop this complication.

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Mesothelioma, Lung Cancer, Lung Adenocarcinoma, Bilateral, Collagen, Chemotherapy.

Related studies

• Pemetrexed-induced eyelid edema in lung cancer — P.R. Martins-Filho, S.Y. Kameo, et al. (2013)
• Liposomal pemetrexed: formulation, characterization and in vitro cytotoxicity studies for effective management of malignant pleural mesothelioma — N. Essam Eldin, H.M. Elnahas, et al. (2015)
• Combined hyaluronate-based films loaded with pemetrexed and cisplatin for the treatment of malignant pleural mesothelioma: Preliminary evaluation in an orthotopic tumor recurrence model — F. Sonvico, S. Barbieri, et al. (2018)
• Safety of Same-Day Vitamin B12 Supplementation in Patients Receiving Pemetrexed for the Treatment of Non-Small-Cell Lung Cancer or Pleural Mesothelioma: A Retrospective Analysis — Z. Schlei, W. Tan, et al. (2018)
• Optimal Dose of Vitamin D3 400 I.U. for Average Adults has A Significant Anti-Cancer Effect, While Widely Used 2000 I.U. or Higher Promotes Cancer: Marked Reduction of Taurine & 1α, 25(OH)2D3 Was Found In Various Cancer Tissues and Oral Intake of Optimal Dose of Taurine 175mg for Average Adults, Rather Than 500mg, Was Found to Be A New Potentially Safe and More Effective Method of Cancer Treatment — Y. Omura, D. Lu, et al. (2016)
• Raltitrexed plus cisplatin is cost-effective compared with pemetrexed plus cisplatin in patients with malignant pleural mesothelioma — B. Woods, N. Paracha, et al. (2012)

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