Multiple choroidal metastases treatment with alectinib

Author: Gianfranco Bellizzi (Italy)

Co-authors:

Purpose

Evaluation of the effectiveness of systemic therapy with alectinib for multiple choroidal metastases from small cell lung adenocarcinoma by multi-imaging techniques and simultaneous assessment of the possible retinotoxicity of the drug.

Setting/Venue

Studio Oculistico Bellizzi, Bari IT (June 2020 - December 2020)

Methods

Case report of a young oncological patient, with a decreased visual acuity in right eye and metamorphopsia with normal visual acuity in left eye, presenting multiple choroidal metastases in right eye and a single lesion in left eye from lung derivation. The greater infiltration had a diameter of 6mm. and the remaining of 5mm. and 3mm. Chronic retinal edema with considerable infiltrations towards the inner retina and optic disc compression in right eye were found. CT and PET confirmed the presence of multiple lesions in the CNS. The OCT confirmed the size of choroidal lesions; VEP, ERG, EOG and campimetry were also made.

Results

Follow-up at 2nd month after therapy with 1200mg daily dosage showed a complete restore of visual acuity in right eye, with metamorfopsia, slight photophobia from choroidal scars with a considerable reduction in metastases until to their disappearance. An improvement of amplitude in VEP and ERG tracks, with a good campimetry data, confirmed the fully functional recovery in the responder patient. The same clinical objectivity was confirmed at the 6th month follow-up by MRI.

Conlusions

Choroidal metastases from lung derivation can be found in 25% of patients. Therapeutic management isn’t always easy because the diagnosis is often late; the multi-imaging approach allows a more precise identification, the elective treatment is brachytherapy even if it’s difficult to make in multiple or bilateral lesions. Systemic therapy with alectinib, in this case responder although given for microcellular pattern, allowed the complete resolution of choroid metastases with good intraretinal bioavailability and an absence of retinotoxicity.

Financial Disclosure

None