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

Abstract

Background: Choroidal metastases being the sole presenting feature of lung cancer is rare. Erlotinib, a tyrosine kinase inhibitor (TKI), is used in the treatment of lung adenocarcinoma where tumor cells exhibit epidermal growth factor receptor (EGFR) mutations. We report a case of metastatic non-small-cell lung cancer (NSCLC) with choroidal metastasis, which was the sole presenting feature and which responded to erlotinib.

Methods: We performed a retrospective case review.

Case: A 78-year-old man presented with a choroidal mass which was found to be the presenting feature of metastatic NSCLC. Our patient, a nonsmoker, had disseminated bony metastases, and therefore was advised to undergo palliative chemotherapy, which he refused. He was therefore instituted on oral erlotinib.

Results: Tumor cells expressing EGFR mutations are known to be susceptible to TKIs. Even though the tumor in our case showed no mutation, i.e. was classified as 'wild-type', our patient showed a dramatic response to erlotinib. At 1 year, the choroidal lesion had regressed and visual acuity had recovered.

Conclusions: TKIs may be beneficial in patients with choroidal metastases from NSCLC, especially those in which an EGFR mutation is noted. Even in the absence of such mutations, choroidal metastases may show a favorable effect in response to TKIs, such as erlotinib.

Keywords: Choroidal; Epidermal growth factor receptor; Erlotinib; Lung cancer; Metastases; Non-small-cell lung cancer; Targeted therapy; Tyrosine kinase inhibitors.

Fig. 1

a Fundus photograph at presentation showed a well-defined yellowish-colored circular subretinal lesion along the superior arcade. Also note the small, discrete, pin-point yellowish ‘satellite lesions’ between the optic disc and the macula. b Posttreatment fundus photograph of the left eye showed scarring and exudation. The lesion was however flat with no subretinal fluid.

Fig. 2

Fundus fluorescein angiography showed central hypofluorescence with a ring of peripheral hyperfluorescence in the early phase that gradually increased in intensity and size in the late phase.

Fig. 3

a Pretreatment OCT of the left eye through the macula showed neurosensory detachment with the presence of subretinal fluid. b Posttreatment OCT of the left eye showed a normal foveal contour with no subretinal fluid.

Fig. 4

a At presentation, OCT scan passing through the lesion in the left eye showed an irregular, dome-shaped subretinal lesion. The underlying choroid had an uneven, hump-shaped configuration. b Posttreatment OCT showed dramatic resolution with residual scarring and exudation.

Fig. 5

Photomicrograph showing clusters of malignant cells with hyperchromatic nuclei and increased nuclear-cytoplasmic ratio in a papillary configuration. Hematoxylin-eosin. ×40.