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Milluzzo et al. Metab Target Organ Damage 2024;4:5 Metabolism and
DOI: 10.20517/mtod.2023.43
Target Organ Damage

Review Open Access

Cancer drugs and diabetic retinopathy: a dangerous,
underestimated association

1
1,2
Agostino Milluzzo 1,2 , Lucia Manuella , Lucia Frittitta , Laura Sciacca 1,3
1
Department of Clinical and Experimental Medicine, University of Catania, Catania 95122, Italy.
2
Diabetes and Obesity Center, Garibaldi-Nesima Hospital, Catania 95122, Italy.
3
Endocrinology, Garibaldi-Nesima Hospital, Catania 95122, Italy.
Correspondence to: Prof. Agostino Milluzzo, Department of Clinical and Experimental Medicine, University of Catania, Piazza
Università, Catania 95131, Italy. E-mail: agostino.milluzzo@unict.it
How to cite this article: Milluzzo A, Manuella L, Frittitta L, Sciacca L. Cancer drugs and diabetic retinopathy: a dangerous,
underestimated association. Metab Target Organ Damage 2024;4:5. https://dx.doi.org/10.20517/mtod.2023.43

Received: 5 Nov 2023 Accepted: 22 Jan 2024 Published: 25 Jan 2024
Academic Editors: Amedeo Lonardo, Shazli Azmi, Ketan K. Dhatariya Copy Editor: Dan Zhang Production Editor: Dan Zhang

Abstract
The worldwide growing prevalence of diabetes and cancer led to an increase in subjects affected by both these
diseases that share several of the involved risk factors and have a complex, multifactorial etiopathogenesis. Cancer
therapies could have harmful effects on several organs, particularly in subjects also affected by diabetes and its
related comorbidities. Moreover, cancer diagnosis often monopolizes the attention of both patients and caregivers,
thus reducing the attention to pre-existent diseases. Retinopathy is one of the most frequent microvascular
complications of diabetes, accounting for about 5% of legal blindness worldwide. The retinal neurovascular unit is
dysfunctional in diabetes and could represent a frail site when cancer therapies are administered. Nevertheless, the
short- and long-term effects of the different anticancer molecules on retinal tissue, especially in diabetic subjects,
are poorly known, and no specific recommendations on their prevention and management are available. In this
review, we summarised the current data on this topic, focusing on the different cancer class drugs involved in
retinal damage: anti-oestrogen, classical cytolytic chemotherapy (alkylating agents, taxanes, topoisomerase
inhibitors, and antimetabolites), mitogen-activated protein kinase, tyrosine-kinase, and vascular endothelial growth
factor inhibitors are the cancer drugs associated with retinal damage and visual disturbance. However, further
studies are necessary to improve knowledge on the molecular and clinical relation between cancer therapies and
retinopathy, in order to provide clinicians with evidence-based protocols to optimise the management of these
conditions and minimise vision loss occurrence, impaired quality of life, and public health expense.

Keywords: Diabetes, cancer, retinopathy, blindness, chemotherapy, obesity, chronic complications, hypertension

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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