Choroidal Metastasis of Non-Small Cell Lung Cancer That Responded to Gefitinib

A 52-year-old Japanese woman presented with optical symptoms, including left-sided myodesopsia, blurred vision, narrowed visual field, and diminished visual acuity. Ocular evaluation revealed a metastatic tumor in the choroid. Further examinations identified pulmonary adenocarcinoma as the primary tumor. Because an epidermal growth factor receptor gene (EGFR) mutation was detected in a biopsy specimen, gefitinib treatment was initiated. Dramatic responses were obtained in the primary tumor and metastatic foci. Optical symptoms improved and remained stable for 5 months during the treatment, until relapse. This report demonstrates that gefitinib is effective for choroidal metastasis of pulmonary adenocarcinoma harboring an EGFR mutation. 1. Introduction The choroid is the most common ocular site for metastasis due to its abundant blood supply. Only one-third of patients with choroidal metastasis have the primary tumor site identified at the time of diagnosis [1]. The two major primary sites are the breast and lung, and lung cancer accounts for approximately 30% of choroidal metastasis [2]. Visual symptoms may be the first manifestation of systemic metastases. Visual impairment includes myodesopsia, blurred vision, narrowed visual field, and lower visual acuity. These symptoms are caused not only by the mass effect of the tumor, but also by increased subretinal fluid, retinal edema, and retinal detachment. Persistent retinal detachment ultimately results in irreversible visual loss that greatly reduces the patient’s quality of life (QOL). Because two-third-of-patients with choroidal metastasis of lung cancer are benefitted by any treatment [3], early recognition and therapy are important to maximize a patient’s QOL. In general, systemic chemotherapy alone is effective if the original tumor is susceptible to the cytotoxic agents. Recent progress in molecular targeted drugs has demonstrated favorable outcome for ocular tumors due to their prompt and high response rate [1, 2]. Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKi) is also expected to be a promising treatment for ocular metastasis of non-small cell lung cancer (NSCLC) harboring an EGFR mutation, although little information has been provided. 2. Case Report A 52-year-old Japanese woman, a current smoker, presented with optical symptoms, including left-sided myodesopsia, blurred vision, narrowed visual field, and diminished visual acuity. Because these symptoms gradually became worse, she was referred to the ophthalmologist a month after symptom onset. Ocular evaluation by