Abstract
Introduction
It is not uncommon for patients with non-small cell lung cancer (NSCLC) to develop
choroidal metastases (CM). External beam radiotherapy (EBRT) has traditionally been
considered the treatment of choice for CM as it offers high response rates and quick
relief of symptoms. However, new targeted treatments can offer an effective, alternative
treatment strategy for patients harbouring specific genetic abnormalities.
Case study
We present the case of a patient presenting with a symptomatic metastasis to the choroid
from an epidermal growth factor receptor (EGFR) mutation–positive NSCLC and exhibiting
an excellent clinical and radiological response to the tyrosine kinase inhibitor (TKI)
gefitinib.
Discussion
A review of the literature reveals 6 more reported cases of patients with NSCLC successfully
treated with an EGFR-TKI (gefitinib or erlotinib). There are no prospective or retrospective
studies comparing EBRT with EGFR-TKIs for the treatment of CM in patients with EGFR
mutation–positive NSCLC. All available data suggest that in EGFR mutation–positive
NSCLC patients, EGFR-TKIs can offer response rates, time to response, and duration
of response equivalent to that seen with EBRT. In addition, EGFR-TKIs can promise
a more favourable ophthalmic toxicity profile compared with EBRT.
Conclusion
We conclude that initial treatment with an EGFR-TKI is a reasonable option for patients
presenting with EGFR mutation–positive NSCLC and a CM. EBRT can be reserved for those
who either do not respond to treatment with an EGFR-TKI or have recurrence after initial
therapy.
Abstract
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References
- Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients.Ophthalmology. 2014; 121: 352-357
- Management of choroidal metastases.Cancer Treat Rev. 2014; 40: 1119-1128
- A novel approach in the treatment of cancer: targeting the EGFR pathway for cancer therapy.Clin Cancer Res. 2001; 7: 2958-2970
- Gefitinib or carboplatin–paclitaxel in pulmonary adenocarcinoma.N Engl J Med. 2009; 361: 947-957
- Radiotherapy of choroidal metastases.Radiother Oncol. 1998; 46: 263-268
- A case of choroidal metastasis of lung cancer successfully treated with erlotinib.Gan To Kagaku Ryoho. 2012; 39: 269-271
- Choroidal metastasis of non-small cell lung cancer that responded to gefitinib.Case Rep Ophthalmol Med. 2013; 2013: 213124
- Choroidal metastasis with adenocarcinoma of the lung treated with gefitinib.Eur J Ophthalmol. 2010; 20: 963-965
- Complete regression of choroidal metastasis secondary to non-small-cell lung cancer with intravitreal bevacizumab and oral erlotinib combination therapy.Ophthalmologica. 2009; 223: 411-413
- Uveal metastasis from nonsmall cell lung carcinoma with dramatic response to erlotinib.Retin Cases Brief Rep. 2010; 4: 390-393
- Rapid regression of choroidal metastasis from lung cancer using erlotinib (Tarceva).Oman J Ophthalmol. 2014; 7: 75-77
- Health-related quality-of-life in a randomized phase III first-line study of gefitinib versus carboplatin/paclitaxel in clinically selected patients from Asia with advanced NSCLC (IPASS).J Thorac Oncol. 2011; 6: 1872-1880
- Functional vision is improved in the majority of patients treated with external-beam radiotherapy for choroid metastases: a multivariate analysis of 188 patients.J Clin Oncol. 1997; 15: 1244-1251
Article info
Publication history
Accepted:
September 28,
2016
Received in revised form:
August 12,
2016
Received:
March 15,
2016
Identification
Copyright
© 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
