Successful response to first-line treatment with osimertinib for choroidal metastasis from EGFR-mutated non-small-cell lung cancer

Field, Matthew G.; Boldt, H. Culver; Hejleh, Taher Abu; Binkley, Elaine M.

doi:10.1016/j.ajoc.2022.101459

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Previously, osimertinib was often reported as a second-line therapy [ 4 , 7 , 8 , 11 ], but since the FLAURA trial, osimertinib has been used as a first-line therapy. However, few reports have demonstrated the efficacy of osimertinib as a first-line therapy for metastatic choroidal tumors [ 9 , 10 ]. Field et al [ 9 ] found that choroidal metastases in a patient with NSCLC and exon 19 EGFR and TP53 mutations resolved completely after 3 months of the first-line therapy with osimertinib.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…However, few reports have demonstrated the efficacy of osimertinib as a first-line therapy for metastatic choroidal tumors [ 9 , 10 ]. Field et al [ 9 ] found that choroidal metastases in a patient with NSCLC and exon 19 EGFR and TP53 mutations resolved completely after 3 months of the first-line therapy with osimertinib. They reported complete resolution within 3 months and maintenance for 17 months.…”

Section: Discussion/conclusionmentioning

confidence: 99%

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Effect of the First-Line Therapy with Osimertinib for a Metastatic Choroidal Tumor in Advanced-Stage Lung Cancer: A Case Report

Umeda¹,

Kitamura²,

Yokouchi³

et al. 2023

Case Rep Ophthalmol

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Although the advent of molecular-targeted drugs has improved the prognosis of various cancers, the long-term prognosis and side effects as the first-line therapy for metastatic choroidal tumors remain unclear. We describe a case in which the first-line therapy of osimertinib has shown long-term successful and minimum side effect responses for metastatic choroidal tumors in a patient with advanced-stage lung cancer. The patient was a 62-year-old man who complained of foggy vision and visual field defects in his left eye for 1 month. When he visited his local doctor, a serous retinal detachment was noted in the left eye, and he was referred to our hospital for further examination. The patient had no history of systemic disease. A fundus examination of his left eye showed a slightly elevated choroidal lesion along with the superior retinal vascular arcade. Optical coherence tomography showed a serous retinal detachment around the lesion. Fluorescein angiography showed that the site of the lesion had spotty and mottled hyperfluorescence in the early phase and ring hypofluorescence in the late phase. We suspected a metastatic choroidal tumor and performed a whole-body computed tomography scan, which indicated lung cancer and metastasis to the left iliac bone. The patient was referred to the department of respiratory medicine of our hospital, and after a thorough examination, a diagnosis of lung adenocarcinoma (stage IV-B, epidermal growth factor receptor [EGFR] gene mutation positive) was made. Treatment with osimertinib was initiated, and shrinkage of the primary tumor was observed. The elevated choroidal lesion and serous retinal detachment resolved after 2 months of treatment, and no recurrence was observed during the 20 months of treatment. The use of osimertinib as primary treatment for EGFR mutation-positive lung cancer was found to significantly reduce the size of metastatic choroidal tumors and to have a relatively long-lasting antitumor effect without serious ocular complications.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Discussion/conclusionmentioning

confidence: 99%

Effect of the First-Line Therapy with Osimertinib for a Metastatic Choroidal Tumor in Advanced-Stage Lung Cancer: A Case Report

Umeda¹,

Kitamura²,

Yokouchi³

et al. 2023

Case Rep Ophthalmol

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“…In the FLAURA trial, osimertinib (EGFR-TKI) was shown to be beneficial for untreated, EGFR mutant advanced nonsmall-cell lung carcinoma, showing superior efficacy compared to earlier generation EGFR-tyrosine kinase inhibitors [7]. Osimertinib also has better CNS penetration leading to favorable CNS overall response rates and CNS progressionfree survival and has previously been shown to successfully treat choroidal metastasis in a patient with EGFR-mutated lung adenocarcinoma [8]. In summary, this is the first report to our knowledge of a patient who presented with metastatic choroidal lesion with exudative retinal detachment in one eye and retrobulbar optic nerve infiltration in the fellow eye.…”

Section: Discussionmentioning

confidence: 99%

Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma

Shamim

Whaley

Rana

et al. 2022

Case Reports in Ophthalmological Medicine

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Purpose. To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control. Case. A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI). Conclusion. To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.

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“…Significant clinical regression of metastatic choroidal lesions and improvement in visual acuity have been observed with the use of Osimertinib. It can be used as firstline treatment or as an adjunct to local treatment of choroidal metastases [61,62 & , [63][64][65]. Older generation TKIs for NSCLC with EGFR mutations, such as Erlotinib and Gefitinib, have also been used in choroidal metastases, resulting in resolution of the choroidal lesion in most cases [60].…”

Section: Emerging Systemic Treatment Of Ocular Metastasismentioning

confidence: 99%

Posterior segment manifestations of ocular metastasis

Kongwattananon

Pothikamjorn

Somkijrungroj

2023

Current Opinion in Ophthalmology

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Purpose of review This article reviewed and summarized recent published data on ocular imaging findings and treatment of posterior segment manifestations of ocular metastasis. Recent findings Advanced ocular imaging can help differentiate ocular metastases from other mimicking lesions, including primary intraocular tumors or infections. Recently, case reports have demonstrated the successful use of targeted systemic therapy to achieve local control of vitreous and choroidal metastases. Summary Metastasis can lead to a wide variety of posterior segment ocular manifestations. The choroid is the most common metastatic site, whereas tumor metastasizing to the retina and optic disc are rare. Patients with possible metastatic eye disease are recommended to undergo extensive investigation to determine the underlying primary cancer and ongoing systemic metastases. Currently, there is no consensus on the treatment strategy. Treatment generally includes systemic chemotherapy in combination with local treatment, such as radiotherapy, laser therapy, or anti-vascular endothelial growth factor (anti-VEGF) treatment.

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Successful response to first-line treatment with osimertinib for choroidal metastasis from EGFR-mutated non-small-cell lung cancer

Cited by 5 publications

References 15 publications

Effect of the First-Line Therapy with Osimertinib for a Metastatic Choroidal Tumor in Advanced-Stage Lung Cancer: A Case Report

Effect of the First-Line Therapy with Osimertinib for a Metastatic Choroidal Tumor in Advanced-Stage Lung Cancer: A Case Report

Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma

Posterior segment manifestations of ocular metastasis

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