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.

Figure 1

Regression of choroidal metastasis after intravitreal bevacizumab (Case A). Pre-treatment (left images): (a) Fundus photograph shows yellow mass in the superior sector close to the optic disc, (b) FA demonstrates hypofluorescence due to masking effect with signs of leakage, (c) B-scan echography shows a medium-high reflective choroidal mass above the optic disc, (d) OCT demonstrates serous detachment of the neuroepithelium. Post-treatment (right images): (e) Fundus photograph shows regression of the choroidal mass, (f) FA demonstrates pigmentary changes with hypo-hyperfluorescent areas and signs of scarring due to flattening of the mass, (g) B-scan echography shows regression of the mass, (h) OCT demonstrates resolution of the serous detachment.