Corneal Perforation as a Possible Ocular Adverse Event by Cabozantinib: A Clinical Case and Brief Review

Cabozantinib is a Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitor (VEGFR-TKI). These drugs are employed as therapy for several malignancies. In detail, Cabozantinib demonstrated its efficacy against Renal Cell Carcinoma, Hepatocellular carcinoma, and Medullary Thyroid Carcinoma. On the other hand, Cabozantinib can be responsible for various adverse events (AEs) that are common to the VEGFR-TKI family, in particular hepatic and dermatological AEs. In literature, few data have been divulged about ocular AEs due to therapy with these drugs. In this regard, only one case of corneal perforation during treatment with a VEGFR-TKI, Regorafenib, has been reported. In this paper, we present another clinical case of corneal perforation in a patient affected by advanced RCC and treated with Cabozantinib as second-line therapy. The patient started Cabozantinib at the dosage of 60 mg/die although it was necessary to apply some dose reductions because of grade 2 AEs (according to CTCAE v6.0) such as asthenia, diarrhea, dysgeusia, and loss of appetite. However, after approximately 15 months of treatment, the patient began to experience pain and vision loss in the right eye. Thus, the diagnosis of corneal perforation, medical and surgical treatment were performed as well as the interruption of Cabozantinib administration. VEGFR-TKIs’ mechanisms of action suggest a possible correlation with this AE. Therefore, particular importance should be given to ophthalmologic surveillance during treatment with these drugs, in any case of ocular symptoms.