Umeda Ikuko, Kitamura Yuta, Yokouchi Hirotaka, Baba Takayuki
Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Ophthalmology, National Hospital Organization Chiba Medical Center,Chiba, Japan.
Case Rep Ophthalmol. 2023 Jul 13;14(1):331-339. doi: 10.1159/000531255. eCollection 2023 Jan-Dec.
Although the advent of molecular-targeted drugs has improved the prognosis of various cancers, the long-term prognosis and side effects as the first-line therapy for metastatic choroidal tumors remain unclear. We describe a case in which the first-line therapy of osimertinib has shown long-term successful and minimum side effect responses for metastatic choroidal tumors in a patient with advanced-stage lung cancer. The patient was a 62-year-old man who complained of foggy vision and visual field defects in his left eye for 1 month. When he visited his local doctor, a serous retinal detachment was noted in the left eye, and he was referred to our hospital for further examination. The patient had no history of systemic disease. A fundus examination of his left eye showed a slightly elevated choroidal lesion along with the superior retinal vascular arcade. Optical coherence tomography showed a serous retinal detachment around the lesion. Fluorescein angiography showed that the site of the lesion had spotty and mottled hyperfluorescence in the early phase and ring hypofluorescence in the late phase. We suspected a metastatic choroidal tumor and performed a whole-body computed tomography scan, which indicated lung cancer and metastasis to the left iliac bone. The patient was referred to the department of respiratory medicine of our hospital, and after a thorough examination, a diagnosis of lung adenocarcinoma (stage IV-B, epidermal growth factor receptor [] gene mutation positive) was made. Treatment with osimertinib was initiated, and shrinkage of the primary tumor was observed. The elevated choroidal lesion and serous retinal detachment resolved after 2 months of treatment, and no recurrence was observed during the 20 months of treatment. The use of osimertinib as primary treatment for EGFR mutation-positive lung cancer was found to significantly reduce the size of metastatic choroidal tumors and to have a relatively long-lasting antitumor effect without serious ocular complications.
尽管分子靶向药物的出现改善了各种癌症的预后，但作为转移性脉络膜肿瘤一线治疗的长期预后和副作用仍不明确。我们描述了一例病例，其中奥希替尼作为一线治疗对一名晚期肺癌患者的转移性脉络膜肿瘤显示出长期成功且副作用最小的反应。该患者为一名62岁男性，因左眼视物模糊和视野缺损1个月前来就诊。当他去当地医生处就诊时，左眼被发现有浆液性视网膜脱离，随后被转诊至我院进一步检查。该患者无全身疾病史。左眼眼底检查显示沿视网膜上血管弓有一个略隆起的脉络膜病变。光学相干断层扫描显示病变周围有浆液性视网膜脱离。荧光素血管造影显示病变部位在早期有斑点状和斑驳状高荧光，晚期有环形低荧光。我们怀疑是转移性脉络膜肿瘤，并进行了全身计算机断层扫描，结果显示有肺癌并转移至左髂骨。该患者被转诊至我院呼吸内科，经过全面检查，诊断为肺腺癌（IV - B期，表皮生长因子受体[]基因突变阳性）。开始使用奥希替尼治疗，观察到原发肿瘤缩小。治疗2个月后，隆起的脉络膜病变和浆液性视网膜脱离消失，在20个月的治疗期间未观察到复发。发现将奥希替尼作为表皮生长因子受体突变阳性肺癌的一线治疗可显著缩小转移性脉络膜肿瘤大小，并具有相对持久的抗肿瘤作用，且无严重眼部并发症。
