Tyrosine kinase inhibitor: An alternative treatment for non–small-cell lung cancer metastasis to the choroid

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A Chinese study, led by Arnold ASH Chee, AFCOphthHK, found that a tyrosine kinase inhibitor achieved both durable disease control and visual improvement in patients with epidermal growth factor receptor mutation-positive non–small-cell lung carcinoma that had metastasized to the choroid.¹

He is from the Departments of Ophthalmology and Visual Sciences of the Chinese University of Hong Kong, the Prince of Wales Hospital; and the Alice Ho Miu Ling Nethersole Hospital, all in Hong Kong.

He and his colleagues conducted a retrospective review that spanned 10 years with the goals of describing the clinical characteristics of choroidal metastasis in this patient population and to report treatment outcomes after targeted therapy compared with conventional radiotherapy and/or chemotherapy, he explained.

The study included 25 eyes of 21 Chinese patients, mostly non-smokers, with choroidal metastasis secondary to metastatic non–small-cell lung carcinoma.

The authors reported that at diagnosis, 88% of the eyes had visual symptoms with a mean visual acuity of 20/100, and 52% of the tumors were in the macula.

Treatment with tyrosine kinase inhibitor monotherapy, tyrosine kinase inhibitor with radiotherapy, and radiotherapy and/or chemotherapy groups all achieved similar responses of the tumor from 1 month and comparable ocular progression-free indices. The monotherapy group achieved the most rapid and differential visual gain compared with the other treatment groups.

Patients who were not treated had visual deterioration and no response of the tumor.

The authors concluded, “Tyrosine kinase inhibitor achieved durable disease control in epidermal growth factor receptor mutation-positive non–small-cell lung carcinoma in patients with choroidal metastasis, while improving visual function. A tyrosine kinase inhibitor can be considered as an alternative to conventional orbital radiotherapy or chemotherapy for these patients in view of the rapid visual recovery.”

Reference

1. Chee ASH, Mak ACY, Kam KW, et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitor in treating choroidal metastasis from non–small-cell lung cancer: a 10-year review. Retina. 2025;45:207-214. doi: 10.1097/IAE.0000000000004314