摘要

抗體藥物複合體(antibody-drug conjugates, ADCs) 為新興標靶抗癌藥物，兼具高專一性與細胞毒性，已廣泛應用於多種惡性腫瘤。然而，臨床使用過程中可能引發眼部不良事件，尤以角膜病變最常見，症狀包括乾眼、畏光、結膜炎及視力模糊，嚴重者恐影響治療持續性與視覺功能。ADCs 相關眼部毒性之機轉可分為標靶性毒性與非標靶性毒性，其中以後者為主。非標靶性機轉涉及連接子穩定性不足、非專一性細胞攝取、旁觀者效應及細胞毒性藥物特性等因素。目前尚缺乏統一之預防與處置指引，現有建議多源自臨床試驗與仿單資訊。處置策略包括避免配戴隱形眼鏡、使用不含防腐劑人工淚液、短期局部類固醇、血管收縮劑、輸注期間冷敷，以及治療前後眼科評估。對於第二級以上眼部不良事件，應考慮暫停或減量給藥；若為嚴重或不可逆病變，則需停藥。本綜論彙整已核准上市ADCs 相關眼部不良事件之臨床表現、致病機轉及處置策略，並強調跨領域合作之重要性，以兼顧治療效益與視覺安全。

 

ABSTRACT

Antibody-drug conjugates (ADCs) are emerging targeted anticancer agents that combine high specificity with potent cytotoxicity and have been widely applied in the treatment of various malignancies. However, their clinical use can lead to ocular adverse events (AEs), most commonly corneal disorders, presenting as dry eye, photophobia, conjunctivitis, and blurred vision, which may compromise treatment continuity and visual function in severe cases. The underlying mechanisms of ADCrelated ocular toxicity can be categorized as on-target and off-target toxicity, with the latter being predominant. Off-target mechanisms involve linker instability, nonspecific cellular uptake, bystander effects, and physicochemical properties of the cytotoxic payload. Currently, no standardized guidelines exist for the prevention and management of these AEs; available recommendations are largely derived from clinical trials and prescribing information. Management strategies include avoiding contact lens use, frequent application of preservative-free artificial tears, short-term topical corticosteroids, ocular vasoconstrictors, cold compresses during infusion, and ophthalmologic evaluation before and throughout therapy. For Grade ≥ 2 ocular AEs, treatment interruption or dose reduction is advised, while permanent discontinuation should be considered for severe or irreversible cases. This review summarizes the clinical manifestations, pathogenic mechanisms, and management strategies of ocular AEs associated with approved ADCs, while emphasizing the importance of multidisciplinary collaboration to ensure both therapeutic efficacy and visual safety.

 

 

Submitted for publication: 2025.06.02; Accepted for publication: 2025.10.22