Choroidal metastasis from non-small-cell lung cancer responsive to Osimertinib: a case report

Purpose To report a case of a choroidal metastasis from a non-small-cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) mutation, which responded to Osimertinib, a third-generation EGFR-tyrosine kinase inhibitor (TKI). Background First- and second-generation EGFR-TKis have been widely used for advanced NSCLC patients; however, acquired resistance to these inhibitors, as T790M mutation, could be present in resistant cases. Third-generation EGFR-TKis have emerged as potential therapeutics to overcome this resistance. Methods A 54-year-old lady, affected by pulmonary adenocarcinoma with systemic metastases, was diagnosed with choroidal metastasis and since tumor biopsy was positive for the EGFR-T790M mutation, she was included in ASTRIS study, and she received 80 mg tablet of Osimertinib once a day. Results After a 2-week course of daily therapy with Osimertinib, the improvement of visual acuity was evident with the marked disappearance of visual field defects. We also report a dramatic anatomical reduction of choroidal mass on fundus examination and SD-OCT. These features remained stable at the 4-month follow-up visit. Conclusion This report demonstrates that Osimertinib is effective for choroidal metastasis of NSCLC harboring an EGFR-T790M mutation, which has progressed on or after first- or second-generation EGFR-TKI therapy.