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Suzani M, Benatti E, Ceola S, Coppola M. ISOLATED VITREOUS METASTASIS IN A PATIENT WITH AN ANAPLASTIC LYMPHOMA KINASE-POSITIVE LUNG CANCER TREATED WITH LORLATINIB. Retin Cases Brief Rep 2024; 18:194-198. [PMID: 36228188 DOI: 10.1097/icb.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe the ocular clinical and imaging findings of a patient with isolated vitreous metastasis, confirmed by vitreous biopsy, from an anaplastic lymphoma kinase (ALK)-positive metastatic lung cancer. METHODS Case report. RESULTS A 47-year-old woman with a history of metastatic ALK-positive lung cancer was referred by her oncologist because of unilateral blurred vision over 4 weeks. The fundus examination showed vitreous opacities with clumps of nonpigmented cells, without vasculitis or retinitis, whereas optical coherence tomography showed hyperreflective deposits on the inner retinal surface with no retinal involvement. Diagnostic vitrectomy revealed neoplastic cells with ALK mutation. CONCLUSION This is the first report that documents a case of isolated vitreous metastasis from ALK-positive lung cancer in a patient under targeted therapy to treat metastatic lung cancer. We emphasize the importance of multimodal imaging, diagnostic vitrectomy, and a pathologist's cooperation to provide essential information about diagnosis and effective treatment.
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Affiliation(s)
- Martina Suzani
- Department of Ophthalmology, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Eleonora Benatti
- Department of Ophthalmology, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Stefano Ceola
- Department of Pathology, San Gerardo Hospital, ASST-Monza, Monza, Italy; and
- University of Milano Bicocca, Milan, Italy
| | - Michele Coppola
- Department of Ophthalmology, San Gerardo Hospital, ASST-Monza, Monza, Italy
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2
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Zhou Y, Yin Y, Xu J, Xu Z, Yang B, He Q, Luo P, Yan H, Yang X. An update on Alectinib: a first line treatment for ALK-positive advanced lung cancer. Expert Opin Pharmacother 2023; 24:1361-1373. [PMID: 37278051 DOI: 10.1080/14656566.2023.2221786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Alectinib is a second-generation, anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) for the treatment of ALK+ non-small cell lung cancer (NSCLC) and is able to induce significant and durable CNS responses. However, long-term use of alectinib has been clinically reported to cause some serious and even life-threatening adverse events. There are currently no effective interventions for its adverse events, and this undoubtedly leads to delays in patient treatment and limits its long-term clinical use. AREAS COVERED Based on the clinical trials conducted so far, we summarize the efficacy and adverse events that occurred, especially those related to cardiovascular disorders, gastrointestinal disorders, hepatobiliary disorders, musculoskeletal and connective tissue disorders, skin and subcutaneous tissue disorders, and respiratory disorders. The factors that may influence alectinib selection are also described. Findings are based on a PubMed literature search of clinical and basic science research papers spanning 1998-2023. EXPERT OPINION The significant prolongation of patient survival compared with first-generation ALK inhibitor suggests its potential as a first-line treatment for the NSCLC, but the severe adverse events of alectinib limit its long-term clinical use. Future research should focus on the exact mechanisms of these toxicities, how to alleviate the adverse events caused by alectinib clinically, and the development of next-generation drugs with reduced toxicities.
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Affiliation(s)
- Yourong Zhou
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yiming Yin
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jiangxin Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacy, Hangzhou Red Cross Hospital (Hangzhou Chest Hospital Affiliated to Zhejiang University Medical College), Hangzhou, China
| | - Zhifei Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Qiaojun He
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Innovation Institute for Artificial Intelligence in Medicine, Zhejiang University, Hangzhou, China
| | - Peihua Luo
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Department of Pharmacology and Toxicology, Hangzhou Institute of Innovative Medicine, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Yan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Xiaochun Yang
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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Nishiyama A, Hattori Y, Takeuchi S, Tanimoto A, Satouchi M, Murayama T, Yano S. Severe Skin Toxicity Caused by Sequential Anti-PD-1 Antibody and Alectinib in Non-small-cell Lung Cancer: A Report of Two Cases and a Literature Review. Intern Med 2022; 61:1735-1738. [PMID: 34803090 PMCID: PMC9259316 DOI: 10.2169/internalmedicine.7472-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have demonstrated marked efficacy in some cancer patients, but they may cause various severe immune-related adverse events. Alectinib is a second-generation anaplastic lymphoma kinase (ALK)-tyrosine kinase inhibitor (TKI) approved for ALK-rearranged non-small-cell lung cancer (NSCLC). Alectinib is said to be safer than other TKIs. We conducted an investigator-initiated trial of alectinib, which also has RET kinase-inhibitory activity, against RET-rearranged NSCLC. Two RET-rearranged NSCLC patients experienced severe skin toxicity with alectinib after first undergoing anti-PD-1 antibody treatment with an ICI. These findings suggest that we should carefully follow patients for adverse effects of targeted drugs following ICI treatment.
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Affiliation(s)
- Akihiro Nishiyama
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
- Cancer Center, Kanazawa University Hospital, Japan
| | | | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
- Cancer Center, Kanazawa University Hospital, Japan
| | - Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
- Cancer Center, Kanazawa University Hospital, Japan
| | | | - Toshinori Murayama
- Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan
- Cancer Center, Kanazawa University Hospital, Japan
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4
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Liu S, Liu X, Wang T, Zeng C, Ren B, Yu X, Xu M, Li W, Qiao Z, You C, Yang Q, Chen M. Effective Systemic Treatment of Choroidal Metastases NSCLC With Surgery After Crizotinib: A Case Report. Front Oncol 2022; 12:789941. [PMID: 35433411 PMCID: PMC9009287 DOI: 10.3389/fonc.2022.789941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Choroidal metastasis as an initial presenting feature of lung cancer with EML4-ALK translocation is exceedingly rare and greatly impacts patient quality of life (QOL). There are no recommended treatments for such patients, and palliative care remains limited. It is unclear whether surgical resection of primary pulmonary lesions, systemic antitumor therapy, targeted therapy, or localized ocular therapy are effective in treating choroidal metastases in EML4-ALK rearranged oligometastatic non-small cell lung cancer (NSCLC). Here, we present the case of choroidal metastases secondary to lung cancer and EML4-ALK translocation in a 57-year-old woman who firstly underwent resection of lung lesions followed by oral administration of crizotinib without local treatment or systemic chemotherapy. Since then she had a rapid and complete response to crizotinib with 27 months of progression-free survival.
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Affiliation(s)
- Shilan Liu
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Liu
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Ting Wang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Chunhua Zeng
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Baichen Ren
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Xiaodan Yu
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Min Xu
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Wenjuan Li
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Zhihui Qiao
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Chuanyun You
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Qinghui Yang
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
| | - Mei Chen
- Department of Respiratory and Critical Care Medicine, Chengdu Fifth People’s Hospital, Chengdu, China
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Seegobin K, Majeed U, Lou Y, Zhao Y, Manochakian R. Patients with high-grade alectinib-induced skin rash: How do we desensitize these patients? A case report and review of literature. SAGE Open Med Case Rep 2020; 8:2050313X20966895. [PMID: 33149916 PMCID: PMC7586266 DOI: 10.1177/2050313x20966895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
With the advent of targeted therapy for non-small-cell lung cancer, there are many new available treatment options for patients whose cancer harbors an actionable mutation or alteration. These new medications come with numerous side effects, for some of which, the management is not well defined. Alectinib is a second-generation tyrosine kinase inhibitor approved for stage-IV lung adenocarcinoma with anaplastic lymphoma kinase gene rearrangement. Severe (⩾Grade 3) skin rash is a rare side effect of alectinib. Reintroducing alectinib in patients with severe skin rash is not well defined in the medical literature. While other case reports have outlined their approach and desensitization protocol, the maximum dose that patients were titrated up to in a desensitization protocol was 300 mg twice daily. Here, we report a case of Grade 3 skin rash secondary to alectinib, and our experience in managing the rash and reintroducing alectinib with a unique desensitization protocol to a max of 600 mg twice daily (full dose). This case could provide further guidance to oncologists managing patients with this adverse event and may aid in reducing concerns to both patients and physicians about recurrence of skin rash at the maximum dose.
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Affiliation(s)
- Karan Seegobin
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Umair Majeed
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Yanyan Lou
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Yujie Zhao
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
| | - Rami Manochakian
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic Jacksonville, FL, USA
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Local and Systemic Management of Uveal Metastasis. Int Ophthalmol Clin 2020; 60:13-26. [PMID: 33093314 DOI: 10.1097/iio.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gozzi E, Angelini F, Rossi L, Leoni V, Trenta P, Cimino G, Tomao S. Alectinib in the treatment of ocular metastases of ALK rearranged non small cell lung cancer: Description of 2 case reports. Medicine (Baltimore) 2020; 99:e21004. [PMID: 32629718 PMCID: PMC7337409 DOI: 10.1097/md.0000000000021004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Choroidal metastasis is a rare metastatic location although the most common intraocular neoplasm. In general, choroidal metastases respond favorably to systemic therapy targeted toward the primary neoplasm. In patients with choroidal metastasis of ALK rearranged non small cell lung cancer (NSCLC), targeted therapy using Alk inhibitors gradually replaced radiotherapy as the best treatment. Alectinib is a second-generation ALK inhibitors. Here we describe 2 clinical cases of patients with choroidal metastasis of ALK rearranged NSCLC who received Alectinib as first-line therapy achieving disease control and quality of life improvement. PATIENTS CONCERNS In case report 1, 62-year-old man presented with scintillated scotomas at the level of the right eye; in case report 2, 69-year-old man presented with respiratory distress, persistent cough resistant to medical therapy, pain, and blurred vision. DIAGNOSES In case report 1, fundus and ultrasonographic examination showed circumscribed choroid thickening with dome-like appearance compatible with repetitive lesion. Computed tomographic/y (CT) showed multiple bilateral pulmonary nodular formations and adenocarcinoma of the lung was diagnosed by a transbronchial biopsy.In case report 2, CT showed a primary lesion of 36 × 27 mm in the middle lobe with bilateral lung metastases and lymphadenopathies. Multiple hepatic metastases and minor suspicious bone repetitions. A liver biopsy made a diagnosis of adenocarcinoma compatible with pulmonary primitiveness. An ocular fluoroangiography evidenced a left choroidal metastasis. INTERVENTIONS Case report 1, 2, medical treatment with Alectinib 1200 mg/day was initiated. OUTCOMES In case report 1, a few days after beginning the treatment, both systemic symptoms like respiratory distress and low vision were palliated. Reassessment by CT confirmed treatment response. In case report 2, clinically, visus disorders had already improved 2 weeks after beginning treatment. CT showed pulmonary, nodal, and hepatic response. Stability of bone metastases occurred after 2 months. In addition, ocular ultrasonography documented the regression of previously reported lesions confirmed treatment response. LESSONS Alectinib works very well in intracranial metastases and is assumed to be so on the ocular ones as well, with benefit for the patient in quality of life.
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Affiliation(s)
- Elisa Gozzi
- UOC of Oncology, University of Rome “Sapienza,” Aprilia (LT)
| | | | - Luigi Rossi
- UOC of Oncology, University of Rome “Sapienza,” Aprilia (LT)
| | | | | | - Giuseppe Cimino
- Department of Medical Oncology, Sapienza University of Rome, Medical and Surgical Sciences and Biotechnology
| | - Silverio Tomao
- Division of Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome
- Consorzio Interuniversitario per la Bio-Oncologia (CINBO), Chieti, Italy
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8
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Chang X, Liu Z, Man S, Roys A, Li Z, Zuo D, Wu Y. Metastasis manners and the underlying mechanisms of ALK and ROS1 rearrangement lung cancer and current possible therapeutic strategies. RSC Adv 2019; 9:17921-17932. [PMID: 35520562 PMCID: PMC9064669 DOI: 10.1039/c9ra02258a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/01/2019] [Indexed: 11/21/2022] Open
Abstract
The rearrangements of anaplastic lymphoma kinase (ALK) and the c-ros oncogene 1 (ROS1) have both been important driving factors in non-small-cell lung cancer (NSCLC). They have already been defined in 3-5% of NSCLC patients. ALK and ROS1 rearrangements are associated with unique clinical and pathological features, especially patients are usually younger, with milder or never smoking history, and adenocarcinoma histology. Also, they have both been found to contribute to the metastasis of NSCLC by cell migration and invasion. It has recently been recognized that the brain can be considered as a primary site for metastasis in cancers with ALK or ROS1 rearrangements. The present review summarizes the current status of NSCLC metastasis and possible mechanisms based on available evidence, and then we list possible therapeutic strategies so that an increase in control of ALK and ROS1 rearrangement of NSCLC metastases by combination therapy can be translated in an increase in overall survival and prognosis.
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Affiliation(s)
- Xing Chang
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Zi Liu
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Shuai Man
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Annie Roys
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Zengqiang Li
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Daiying Zuo
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Yingliang Wu
- Department of Pharmacology, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
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9
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Dimou A, Ou SHI, Doebele RC. Dramatic Response to Lorlatinib in a Patient With CD74-ROS1-Positive Lung Adenocarcinoma With Acquired F2004V Mutation. JCO Precis Oncol 2019; 3:1900013. [PMID: 32914039 PMCID: PMC7450917 DOI: 10.1200/po.19.00013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Sai-Hong I Ou
- University of California School of Medicine, Irvine, Orange, CA
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10
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Noronha V, Talreja V, Joshi A, Patil V, Mahajan A, Prabhash K. The story of two eyes- What to look for in the patient's eyes? CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Guo Y, Wang X, Xiao J, Xu Y, Cai Y, Sun C, Ma K. Lung squamous cell carcinoma with solitary ocular metastasis and its successful treatment with thoracic surgery and chemotherapy: an interesting and rare case report. BMC Cancer 2018; 18:1004. [PMID: 30342504 PMCID: PMC6195964 DOI: 10.1186/s12885-018-4944-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of ocular metastasis from lung cancer is reported to be 0.1–7%, with adenocarcinoma and small cell lung cancer accounting for the highest proportions of these cases. The majority of cases involves metastasis to more than one other distal organ in addition to the eye. Here, we report for the first time, a case of lung squamous cell carcinoma with solitary symptomatic ocular metastasis as the initial manifestation that was managed by a multidisciplinary treatment (MDT). Case presentation A woman presented at the ophthalmology department of hospital with a 1-week history of left eye pain and blurred vision. Systemic examination led to the diagnosis of central lung cancer in the right lower lobe with ocular metastasis. After consultations with an MDT, including specialists from the surgery, internal medicine, ophthalmology, radiotherapy and imaging departments, the patient underwent surgery and chemotherapy. Her eye symptoms disappeared, and the ocular lesion was well controlled without any specific ocular treatment. The patient demonstrated a prolonged progression-free survival. Conclusion This is the first report of a rare case with solitary ocular metastasis as the initial manifestation of lung squamous cell carcinoma. This rare patient was treated based on evidence-based medicine, indicating the importance of cooperation within an MDT. The successful treatment of this case was reported as a new therapeutic reference for clinicians who encounter similar cases in the future.
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Affiliation(s)
- Ye Guo
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
| | - Xu Wang
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
| | - Jun Xiao
- The Jilin University Second Hospital, No. 218, Ziqiang Street, Changchun, Jilin, 130021, People's Republic of China
| | - Yinghui Xu
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
| | - Yangyang Cai
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
| | - Chao Sun
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China
| | - Kewei Ma
- The Jilin University First Hospital, No. 71, Xinmin Street, Changchun, Jilin, 130021, People's Republic of China.
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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Funazo T, Morita K, Ikegami N, Konishi C, Nakao S, Ariyasu R, Taki M, Nakagawa K, Hwang MH, Yoshimura C, Wakayama T, Nishizaka Y. Successful Treatment with Alectinib for Choroidal Metastasis in Anaplastic Lymphoma Kinase Rearranged Non-small Cell Lung Cancer. Intern Med 2017; 56:2317-2320. [PMID: 28794371 PMCID: PMC5635306 DOI: 10.2169/internalmedicine.8488-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Choroidal metastasis is rare in cancer patients and it may cause visual disturbances that reduce their quality of life. In non-small cell lung cancer (NSCLC), targeted therapy against actionable driver mutations has gradually replaced radiotherapy as the treatment of choice for choroidal metastasis. Recently, there have been several case reports of choroidal metastasis in patients with anaplastic lymphoma kinase (ALK)-rearranged NSCLC. We herein report the case of a 40-year-old Japanese woman diagnosed with choroidal metastasis of an ALK-rearranged NSCLC who received alectinib as the first-line chemotherapy. Alectinib may be the best treatment for choroidal metastasis in patients harboring an ALK translocation because of its favorable side effect profile involving visual disturbances.
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Affiliation(s)
- Tomoko Funazo
- Department of Respiratory Medicine, Kyoto University, Japan
| | - Kyohei Morita
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Naoya Ikegami
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Chisato Konishi
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Satoshi Nakao
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Ryo Ariyasu
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Masato Taki
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | | | - Moon Hee Hwang
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | - Chie Yoshimura
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
| | | | - Yasuo Nishizaka
- Department of Respiratory Medicine, Osaka Red Cross Hospital, Japan
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