Tyrosine Kinase Inhibitors in the Treatment of Choroidal Metastases from Non-Small-Cell Lung Cancer: A Case Report and Review of Literature

Nair, Akshay Gopinathan; Asnani, Haresh T; Mehta, Vinod C; Mehta, Siddharth V; Pathak, Rima; Palkar, Amit H; Gopinathan, Indumati

doi:10.1159/000448114

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…5 The development of targeted therapy, especially in pulmonary adenocarcinoma patients with EGFR mutations, provides a therapeutic modality using TKI, which in several case reports gave an improved response to pulmonary adenocarcinoma with eye and orbital metastases. 5,6 Pulmonary adenocarcinoma patients with metastases and EGFR mutations who received TKI therapy had a 5-year survival rate of 14.6%. Deletion of exon 19 and absence of extrathoracic and brain metastases provide better survival.…”

Section: Discussionmentioning

confidence: 99%

“…4 The development of targeted therapy in pulmonary adenocarcinoma with epidermal growth factor receptor (EGFR) mutations provides a therapeutic modality using tyrosine kinase inhibitors (TKI), which in some case reports provide better outcome to pulmonary adenocarcinoma with eye and orbital metastases. 5,6 A 64-year-old male patient complained of swelling, redness, painful and protruded left eye. Initially, the patient experienced a slowly-blurred left eye and narrowed vision of the left eye, resulted in complete loss of vision accompanied by eye pain.…”

Section: Introductionmentioning

confidence: 99%

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EGFR Mutated Lung Adenocarcinoma with Secondary Glaucoma as Early Manifestation: A Case Report

Kusumawardani

Singgih

Candrawati

et al. 2021

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Background: Orbital metastases are rare in pulmonary adenocarcinoma and can be manifested as glaucoma.Case: A 64-year-old male patient complained of swelling, redness, painful and protruded left eye. Physical and radiological examination revealed mass in the right lung, retrobulbar intraconal mass of the left oculi, and metastases in the ribs, liver, brain, and vertebrae. Result of bronchial mucosal biopsy showed adenocarcinoma. Epidermal growth factor receptor (EGFR) mutation examinations detected exon 19 deletions, therefore Gefitinib was given. Left orbital exenteration was performed and obtained a biopsy result of adenocarcinoma metastases.Conclusion: Orbital metastasis occurs by hematogenous pathway due to direct access of systemic circulation to left orbital blood flow. Glaucoma as a symptom of orbital metastases can appear before primary tumor symptoms, because lung cancer often does not show specific symptoms until advanced stage. Definitive treatment consists of targeted therapy and surgical management for metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

EGFR Mutated Lung Adenocarcinoma with Secondary Glaucoma as Early Manifestation: A Case Report

Kusumawardani

Singgih

Candrawati

et al. 2021

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“…The first described choroidal metastasis cases in possibly EGFR-mutant Asian patients (not molecularly assessed), published in 2009–2010, revealed the efficacy of EGFR TKI (in association with intravitreal bevacizumab) [ 15 , 16 ]. Since then, a few case reports have confirmed the ability of first- or second-generation TKIs to induce choroidal metastasis regression in patients with tumor EGFR mutation [ 7 , 17 , 18 ]. The efficacy of third-generation EGFR TKI osimertinib on choroidal metastasis was reported once in an NSCLC patient with T790M EGFR tumor mutation [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Epidermal growth factor receptor-mutant non-small cell lung Cancer and Choroidal metastases: long-term outcome and response to epidermal growth factor receptor tyrosine kinase inhibitors

et al. 2020

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Background Choroidal metastases are the most common eye metastatic site. The prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2 to 7% in historical series. Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). This study sought to describe the prevalence of choroidal metastases among patients with EGFR-mutated NSCLC and their characteristics, and to estimate their impact on prognosis. Methods We conducted a single-center retrospective study including all consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018. The EGFR-mutant NSCLC patients were identified via the Department of Genetics’ files. Patients who exhibited choroidal metastases were compared to patients without choroidal metastases. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups. The study was approved by the IRB as CEPRO number #2020–010. Results Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time. Median follow-up was 42.2 mo (95%CI [37.2–47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1–51.4]) versus 27.9 mo (95%CI [16.9–38.9]) in the non-choroidal metastasis group (p = 0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6 and 0%, respectively, versus 55.8 and 26.3% in the non-choroidal metastasis subset. Conclusions Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.

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“…Similar to our case, both of these patients were initially treated with erlotinib, but eventual disease progression necessitated the switch to osimertinib as second-line treatment. Nair et al [13] reported a case of choroidal metastasis from NSCLC successfully treated with erlotinib. In this review, the authors summarized 8 other cases [14][15][16][17][18][19] of choroidal metastasis from NSCLC treated with first-generation EGFR-TKIs in the literature (erlotinib and gefitinib), finding that the majority of cases improved following treatment with TKIs, thereby suggesting that this class of medication may play an important role in the management of this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Treating Choroidal Metastases and Improving Vision with Osimertinib in EGFR T790M-Mutated Lung Adenocarcinoma: A Case Report and Review of the Literature

Keshwani¹,

Roelofs²,

Hay³

et al. 2020

Ocul Oncol Pathol

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A 41-year-old never-smoking female was diagnosed with epidermal growth factor receptor (EGFR)-mutated T2bN3M1b lung adenocarcinoma with axillary lymph nodes. She complained of blurred vision in the left eye (2/60) and was subsequently found to have a left choroidal metastasis. Treatment with tyrosine kinase inhibitor (TKI) erlotinib was started, and after 1 year of disease stability, she developed unsteadiness and worsening visual disturbance (1/60). Brain imaging showed 24 new brain metastases, which were treated with Gamma Knife stereotactic radiosurgery. An enlarging axillary lymph node was biopsied, which identified the T790M mutation, and she commenced the novel TKI osimertinib. Three weeks later, her choroidal lesion had regressed from 3.1 mm to 2.2 mm, and after 2 months of osimertinib, her visual acuity had improved to 6/9. At the last follow-up 8 months after initiation of osimertinib, her choroidal metastasis remains stable, and visual acuity has improved to 6/6. Evidence suggests that osimertinib’s efficacy in treating cerebral metastases is superior to that of chemotherapy and other EGFR-TKIs (gefitinib and erlotinib); however, the literature is sparse with regards to the use of osimertinib for the treatment of intraocular disease. In this case, the need for intense daily radiation treatment with its associated toxicities was negated, and as such we propose that osimertinib may be a promising treatment for choroidal metastasis secondary to EGFR-mutated lung adenocarcinoma.

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Tyrosine Kinase Inhibitors in the Treatment of Choroidal Metastases from Non-Small-Cell Lung Cancer: A Case Report and Review of Literature

Cited by 11 publications

References 24 publications

EGFR Mutated Lung Adenocarcinoma with Secondary Glaucoma as Early Manifestation: A Case Report

EGFR Mutated Lung Adenocarcinoma with Secondary Glaucoma as Early Manifestation: A Case Report

Epidermal growth factor receptor-mutant non-small cell lung Cancer and Choroidal metastases: long-term outcome and response to epidermal growth factor receptor tyrosine kinase inhibitors

Treating Choroidal Metastases and Improving Vision with Osimertinib in EGFR T790M-Mutated Lung Adenocarcinoma: A Case Report and Review of the Literature

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