Abstract
Symptomatic choroidal metastasis (SCM) is an uncommon manifestation of lung cancer (LC). Treatment of SCM usually includes a combination of systemic therapy (chemotherapy and/or targeted therapy) for the primary tumor as well as local therapy (ocular radiation) for CM. Intravitreal bevacizumab (IV-Bev) is a newer modality being tried for local control of SCM. We describe here two patients with LC who presented with CM and were treated with IV-Bev. We performed a systematic literature review of previously reported patients with CM from LC who were treated with IV-Bev. Six reports (involving seven patients) in which IV-Bev was used as primary treatment modality for CM from LC were identified in the systematic literature review. A total of nine patients (seven previously reported and two index cases) were analyzed further. Along with individual case descriptions of index patients, pooled analysis of demographic profile, histology and outcomes with treatment (systemic and ocular) for the nine patients identified in this systematic review are described. A majority (n = 7) had non-small-cell lung cancer (NSCLC) histology, CM as presenting manifestation (n = 6) and unilateral ocular involvement (n = 8). IV-Bev was used in a dose of either 1.25 mg/cycle (n = 5) or 2.5 mg/cycle (n = 4) with number of cycles varying from 2 to 14 and duration between cycles varying from 2 to 8 weeks. Of the nine patients treated with IV-Bev as the primary ocular treatment modality, six (all non-squamous NSCLC) had favorable ocular response. No short-term ocular complications related to therapy were noted. We suggest that IV-Bev is a promising and safe alternative to ocular radiation for initial treatment of CM from non-squamous NSCLC. However, we recommend against using it for patients with small-cell lung cancer.
References
Giuliari GP, Sadaka A. Uveal metastatic disease: current and new treatment options (review). Oncol Rep. 2012;27:603–7.
Kanthan GL, Jayamohan J, Yip D, Conway RM. Management of metastatic carcinoma of the uveal tract: an evidence-based analysis. Clin Exp Ophthalmol. 2007;35:553–65.
Singh N, Kulkarni P, Aggarwal AN, Rai Mittal B, Gupta N, Behera D, Gupta A. Choroidal metastasis as a presenting manifestation of lung cancer: a report of 3 cases and systematic review of the literature. Medicine (Baltimore). 2012;91:179–94.
Shah SU, Mashayekhi A, Shields CL, Walia HS, Hubbard GB 3rd, Zhang J, Shields JA. Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients. Ophthalmology. 2014;121:352–7.
Chen CJ, McCoy AN, Brahmer J, Handa JT. Emerging treatments for choroidal metastases. Surv Ophthalmol. 2011;56:511–21.
Kim SW, Kim MJ, Huh K, Oh J. Complete regression of choroidal metastasis secondary to non-small-cell lung cancer with intravitreal bevacizumab and oral erlotinib combination therapy. Ophthalmologica. 2009;223:411–3.
De la Barquera Cordero AS, Hidalgo RA. Intravitreal bevacizumab for choroidal metastasis of lung carcinoma; a case report. J Ophthalmic Vis Res. 2010;5:265–8.
D’Antonio C, Viterbo A, Romiti A, Enrici MM, Lauro S, Marchetti P. Complete regression of a non-small cell lung cancer choroidal metastasis with intravitreal bevacizumab. J Thorac Oncol. 2012;7:468–9.
Lai CL, Fan KS, Lee YH, Chen HC, Fan WH. Intravitreal administration of bevacizumab in the treatment of choroidal metastasis in a patient with erlotinib-failed pulmonary adenocarcinoma. Lung Cancer. 2012;76:496–8.
Bhattacharyya T, Kapoor R, Bahl A, Yadav BS, Singh U, Joshi K, Rane S, Sharma SC. Carcinoma lung presenting with choroidal metastasis as initial presentation: a rarity. J Cancer Res Ther. 2013;9:504–6.
Bertino EM, Otterson GA. Benefits and limitations of antiangiogenic agents in patients with non-small cell lung cancer. Lung Cancer. 2010;70:233–46.
Spigel DR, Greco FA, Zubkus JD, Murphy PB, Saez RA, Farley C, Yardley DA, Burris HA 3rd, Hainsworth JD. Phase II trial of irinotecan, carboplatin, and bevacizumab in the treatment of patients with extensive-stage small-cell lung cancer. J Thorac Oncol. 2009;4:1555–60.
Spigel DR, Townley PM, Waterhouse DM, Fang L, Adiguzel I, Huang JE, Karlin DA, Faoro L, Scappaticci FA, Socinski MA. Randomized phase II study of bevacizumab in combination with chemotherapy in previously untreated extensive-stage small-cell lung cancer: results from the SALUTE trial. J Clin Oncol. 2011;29:2215–22.
Yao HY, Horng CT, Chen JT, Tsai ML. Regression of choroidal metastasis secondary to breast carcinoma with adjuvant intravitreal injection of bevacizumab. Acta Ophthalmol. 2010;88:e282–3.
Amselem L, Cervera E, Diaz-Llopis M, Montero J, Garcia-Pous M, Udaondo P, Garcia-Delpech S, Salom D. Intravitreal bevacizumab (Avastin) for choroidal metastasis secondary to breast carcinoma: short-term follow-up. Eye (Lond). 2007;21:566–7.
Kuo IC, Haller JA, Maffrand R, Sambuelli RH, Reviglio VE. Regression of a subfoveal choroidal metastasis of colorectal carcinoma after intravitreous bevacizumab treatment. Arch Ophthalmol. 2008;126:1311–3.
Lin CJ, Li KH, Hwang JF, Chen SN. The effect of intravitreal bevacizumab treatment on choroidal metastasis of colon adenocarcinoma—case report. Eye (Lond). 2010;24:1102–3.
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Venkata Nagarjuna Maturu and Navneet Singh have contributed equally to this work.
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Maturu, V.N., Singh, N., Bansal, P. et al. Combination of intravitreal bevacizumab and systemic therapy for choroidal metastases from lung cancer: report of two cases and a systematic review of literature. Med Oncol 31, 901 (2014). https://doi.org/10.1007/s12032-014-0901-z
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DOI: https://doi.org/10.1007/s12032-014-0901-z