Chemotherapy for eye cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

There are different types of eye cancer. Chemotherapy does not usually work well for melanoma of the eyeball (uveal melanoma). Your specialist is only likely to suggest it if the melanoma comes back after treatment with surgery or radiotherapy.

You might have chemotherapy eye drops to treat melanoma or squamous cell cancer on the surface of the eye (conjunctiva).

You are more likely to have chemotherapy to treat lymphoma of the eye.

Types of chemotherapy

There are a number of chemotherapy drugs that doctors use to treat eye cancer. The types of drugs you have depend on different factors, including your type of eye cancer and where in the eye the cancer is.

For melanoma and squamous cell cancer of the surface of the eye (conjunctiva) you might have:

• mitomycin C
• fluorouracil (5FU)

The chemotherapy drugs that doctors use to treat eye lymphoma include:

• methotrexate
• cytarabine (Ara-C)
• thiotepa
• chlorambucil 

If uveal melanoma has spread to other parts of the body from the eye you might have chemotherapy such as:

• dacarbazine
• temozolomide

Targeted and immunotherapy drugs

You might have a targeted or immunotherapy drug. For example, you may have rituximab with chemotherapy for your lymphoma. Or an immunotherapy drug called ipilimumab for uveal melanoma that has spread. 

How you have chemotherapy

Chemotherapy eye drops (topical chemotherapy)

Doctors may treat some cancers on the surface of the eye (conjunctiva), such as melanoma and squamous cell cancer, with chemotherapy eye drops. This is called topical chemotherapy. Side effects include redness, a watery eye and inflammation.

You may have it on its own or with other treatments such as surgery or cryotherapy (freezing treatment).

Chemotherapy into your bloodstream

If you have eye lymphoma, you are likely to have chemotherapy. Treatment for eye lymphoma depends on the type and stage of lymphoma. You usually have this into your bloodstream.

You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have it through a long line: a central line, a PICC line or a portacath.

These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

In some cases, you may have high doses of chemotherapy followed by a stem cell transplant.

Chemotherapy into the fluid around your spinal cord

If you have eye lymphoma you may also have chemotherapy into the fluid around your spinal cord. This is called intrathecal chemotherapy.

Your doctor injects the drug into the fluid around your spinal cord during a lumbar puncture.

Chemotherapy tablets

You might have methotrexate as a tablet for eye lymphoma.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you miss a dose.

Chemotherapy into the eye (intravitreal chemotherapy)

If you only have lymphoma in your eye, doctors may give the chemotherapy directly into the eye. You are more likely to have this for lymphoma that has come back in the eye (local recurrence). The drug doctors use most often is methotrexate. You usually have regular injections of this over a year. 

Having an injection into your eye may sound daunting, but it is a relatively simple and quick procedure. You have local anaesthetic eye drops beforehand to numb the area. You may feel a little pain when the needle first goes in. Possible side effects from the injection include red eye, infection, inflammation inside the eye and a cataract, which is when the lens becomes misty and you can't see clearly.

Doctors are looking into giving a targeted drug such as rituximab into the eye for lymphoma.

Chemotherapy into the liver

Uveal melanoma can spread to the liver in some people. This spread is called liver secondaries or metastasis. 

Some treatments deliver chemotherapy directly into the liver. Your doctor puts a small tube (catheter) into the main artery leading to your liver. Chemotherapy is injected in to the tube, allowing a high concentration of chemotherapy to get to the secondaries in the liver.

Examples of these treatments include:

• hepatic artery infusion
• transarterial chemoembolisation

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common chemotherapy side effects include:

• feeling sick
• loss of appetite
• losing weight
• feeling very tired
• increased risk of getting an infection
• bleeding and bruising easily
• diarrhoea or constipation
• hair loss

Side effects depend on:

• which drugs you have
• how much of each drug you have
• how you react

Tell your treatment team about any side effects that you have.

When you go home

Chemotherapy for eye cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.