Delayed Diagnosis of Lung Carcinoma Presenting as Choroidal Metastasis in a COVID-19 Patient and Initially Treated with Osimertinib

Background

Until recently, management of choroidal metastases (CM) was based on a set of fairly reliable assumptions. For example, the observation that in patients who present with CM and no relevant oncological history, a chest computed tomography (CT) scan will diagnose lung carcinoma as the primary tumor in a majority of cases. Or the fact that external beam radiation therapy (EBRT) is the standard treatment for CM and is often urgently indicated because of the secondary exudative retinal detachment and risk of blindness [1].

The impact of the COVID-19 pandemic on cancer care has been widely commented, mostly with regard to the discontinuation in screening programs, the risk of iatrogenic infection of patients and staff, and the delay in diagnostic, therapeutic, and follow-up procedures, as well as the suspension of clinical trials [2]. As far as we are aware, there are no specific examples with regard to the effect of COVID-19 on CM management.

The arrival of systemic targeted therapies represents a more important and lasting game-changer, as they have improved life expectancy significantly in cancer patients who harbor the target mutation [1], [3], and specifically in lung cancer patients with EGFR (epidermal growth factor receptor) mutations [4], [5], [6]. However, for CM patients, this better prognosis implies that long-term radiation-induced side effects, in particular secondary ischemic retinopathy or optic neuropathy, become an increasing challenge. The use of targeted therapies as an alternative treatment for CM has been tried with first- and second-generation tyrosine kinase inhibitors (TKIs) such as gefitinib, erlotinib, and afatinib, but met with resistance problems [3], [4], [5], [7], [8]. Osimertinib is a third-generation TKI that inhibits EGFR TKI as well as EGFR T790M resistance mutations, offering an alternative treatment in lung cancer patients. Its efficacy in the setting of CM has only been reported upon in one case [4].

Publikationsverlauf

Eingereicht: 26. September 2021

Angenommen: 10. Februar 2022

Artikel online veröffentlicht:
26. April 2022

• References

• 1 Arepalli S, Kaliki S, Shields CL. Choroidal metastases: origin, features, and therapy. Indian J Ophthalmol 2015; 63: 122-127
• 2 Richards M, Anderson M, Carter P. et al. The impact of the COVID-19 pandemic on cancer care. Nat Cancer 2020; 1: 565-567
• 3 Qu Z, Liu J, Zhu L. et al. A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer. Onco Targets Ther 2021; 14: 4451-4465
• 4 DallʼOlio FG, Ruatta C, Melotti B. et al. Response to Osimertinib in Choroidal Metastases from EGFRmt T790M-Positive Non-Small Cell Lung Adenocarcinoma. J Thorac Oncol 2017; 12: e165-e167
• 5 Sullivan I, Planchard D. Osimertinib in the treatment of patients with epidermal growth factor receptor T790M mutation-positive metastatic non-small cell lung cancer: clinical trial evidence and experience. Ther Adv Respir Dis 2016; 10: 549-565
• 6 Soria JC, Ohe Y, Vansteenkiste J. et al. Osimertinib in Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. N Engl J Med 2018; 378: 113-125
• 7 Nair AG, Asnani HT, Mehta VC. et al. Tyrosine Kinase Inhibitors in the Treatment of Choroidal Metastases from Non-Small-Cell Lung Cancer: A Case Report and Review of Literature. Ocul Oncol Pathol 2017; 3: 28-33
• 8 Maskell D, Kouroupis M, Glenn A. et al. Treatment of choice for patients with EGFR mutation-positive non-small cell lung carcinoma presenting with choroidal metastases: radiotherapy or TKIs?. Can J Ophthalmol 2017; 52: e22-e25
• 9 Rishi P, Appanraj R, Sharma T. Choroidal melanoma masquerading as multifocal central serous chorioretinopathy. Oman J Ophthalmol 2016; 9: 187-188