Intravitreal bevacizumab in the successful management of choroidal metastases secondary to lung and breast cancer unresponsive to systemic therapy: a case series

Abstract

Purpose Management of choroidal metastases is commonly with systemic chemotherapy; however, if tumours are refractory to treatment and vision is endangered, local therapy modalities are feasible. A novel option is the use of intravitreal bevacizumab. This report presents three cases of choroidal metastatic tumours secondary to lung and breast cancer treated with intravitreal bevazizumab. Patients and methods Three patients with choroidal metastases secondary to lung and breast tumours were treated at the Ophthalmology Unit, University of Rome 'Sapienza', S.Andrea Hospital from January 2009 to August 2012. All patients developed vision loss with diagnosis of chorioidal metastasis during systemic chemotherapy. Off label intravitreal bevacizumab treatment was performed with two 1.25 mg injections in two patients and four injections in one patient at 30-day intervals. Results Vision improved, subretinal fluid resolved, and choroidal tumour regression was obtained in all cases. Follow-up was 6, 9, and 12 months and there were no complications related to treatment. Conclusions Intravitreal bevacizumab administration represented an efficacious therapeutic option with rapid effect in the treatment of choroidal metastatic tumours unresponsive to systemic therapy. It can have a role in the management of these tumours by preventing vision loss and improving the quality of life of patients.

Failure of intravitreal bevacizumab in the treatment of choroidal metastasis

“…[2][3][4][5][6][7][8][9] Our outcomes in two cases of adenocarcinoma of caecum, one breast carcinoma, and one adenocarcinoma of lung do not replicate this finding. Difference in pathologies do not explain this, as good effects have been described treating metastases from the same primaries: colon, 4 breast, 2,5,8 and lung. 6 One case, a breast metastasis, who had undergone EBRT in the previous 4 months with no immediate response, did regress after intravitreal bevacizumab.…”

Intravitreal bevacizumab for choroidal metastases: the key to efficacy is simultaneous administration of systemic therapy

“…3 We would also tend to believe that CM from other solid tumors may also have variable degrees of responsiveness to IV-Bev, as has been documented in the literature, including those published in your journal. [4][5][6] In conclusion, while we fully agree with that use of IV-Bev for CM should not delay initiation of other treatment modalities, we strongly believe that this implies using the most appropriate form of systemic therapy in combination with IV-Bev rather than not using IV-Bev at all.…”

Comment on ‘Failure of intravitreal bevacizumab in the treatment of choroidal metastasis’

“…3 We would also tend to believe that CM from other solid tumors may also have variable degrees of responsiveness to IV-Bev, as has been documented in the literature, including those published in your journal. [4][5][6] In conclusion, while we fully agree with that use of IV-Bev for CM should not delay initiation of other treatment modalities, we strongly believe that this implies using the most appropriate form of systemic therapy in combination with IV-Bev rather than not using IV-Bev at all.…”