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].

Publication History

Received: 26 September 2021

Accepted: 10 February 2022

Article published online:
26 April 2022

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