Treatment of choice for patients with EGFR mutation-positive non-small cell lung carcinoma presenting with choroidal metastases: radiotherapy or TKIs?

INTRODUCTION

It is not uncommon for patients with non-small cell lung cancer (NSCLC) to develop choroidal metastases (CM). External beam radiotherapy (EBRT) has traditionally been considered the treatment of choice for CM as it offers high response rates and quick relief of symptoms. However, new targeted treatments can offer an effective, alternative treatment strategy for patients harbouring specific genetic abnormalities.

CASE STUDY

We present the case of a patient presenting with a symptomatic metastasis to the choroid from an epidermal growth factor receptor (EGFR) mutation-positive NSCLC and exhibiting an excellent clinical and radiological response to the tyrosine kinase inhibitor (TKI) gefitinib.

DISCUSSION

A review of the literature reveals 6 more reported cases of patients with NSCLC successfully treated with an EGFR-TKI (gefitinib or erlotinib). There are no prospective or retrospective studies comparing EBRT with EGFR-TKIs for the treatment of CM in patients with EGFR mutation-positive NSCLC. All available data suggest that in EGFR mutation-positive NSCLC patients, EGFR-TKIs can offer response rates, time to response, and duration of response equivalent to that seen with EBRT. In addition, EGFR-TKIs can promise a more favourable ophthalmic toxicity profile compared with EBRT.

CONCLUSION

We conclude that initial treatment with an EGFR-TKI is a reasonable option for patients presenting with EGFR mutation-positive NSCLC and a CM. EBRT can be reserved for those who either do not respond to treatment with an EGFR-TKI or have recurrence after initial therapy.