Rapid vision improvement by using icotinib in a patient with bilateral choroidal metastases symmetrically from lung cancer

Introduction

The metastases of lung cancer to bilateral choroids symmetrically and simultaneously are very rare. Almost all patients with choroid metastasis can be treated with external beam radiotherapy in order to increase quality of life and preserve vision.

Material and Methods

We documented a case and studied the effect of icotinib on choroidal metastases in bilateral eyes simultaneously from pulmonary adenocarcinoma.

Results

A 49-year-old Chinese man presented with bilateral vision losing simultaneously for 4 weeks, it was as an initial presentation in the clinical. The examinations with ophthalmofundoscopy, ultrasonography, and fluorescein angiography showed the lesions in bilateral choroids, two solitary juxtapapillary yellow-white choroidal metastases inferior to the optic discs with bleeding. Positron emission tomography confirmed the choroidal metastases and further proved that it was from lung cancer with lymph nodes and multiple bone metastasis. The biopsy taken from the lung by bronchoscopy and needle biopsy from supraclavicular lymph nodes revealed the pulmonary adenocarcinoma with epithelial growth factor receptor mutation (exon 21). The patient was treated with oral icotinib (125 mg, three times a day, TID). Five days after starting icotinib therapy, the patient's visions were rapidly recovered. Two months after the treatment with icotinib, the choroidal metastases regressed to small lesions, and the visions were preserved to before. The lung tumor and other metastatic lesions were partly regressive. There was no evidence of recurrence for eye lesions at 15-months follow-up. After 17 months treating by icotinib, the patient presented headache and dizzy with multiple brain metastases determined by magnetic resonance imaging; however, the lesions of the choroidal metastases remained progressing-free. Almonertinib with radiotherapy were used to treat the brain metastases, and he is surviving with progress-free more than 2 years until now.

Conclusion

Bilateral choroidal metastases from lung cancer symmetrically are very rare. Icotinib following by almonertinib was an alternative therapy for choroidal metastasis from non-small cell lung cancer with epithelial growth factor receptor mutation.     

阿美替尼二线治疗晚期非小细胞肺癌的疗效观察

目的:探究使用阿美替尼二线治疗驱动基因阳性非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效及安全性并分析影响患者疗效的相关因素。方法:共收集72例2020年03月至2021年03月于我院接受阿美替尼二线治疗的EGFR敏感突变IV期NSCLC患者的临床资料,最终回顾性分析了59例患者使用阿美替尼二线治疗的疗效、安全性及疗效的影响因素。结果:阿美替尼二线治疗IV期EGFR阳性突变NSCLC患者整体中位无进展生存期(mPFS)为12.0个月(95%CI:9.02个月～14.97个月),客观缓解率(ORR)为42.4%,疾病控制率(DCR)为94.9%,其中,T790M阳性突变的患者mPFS为16.0个月(95%CI:13.2个月～18.7个月),无突变者mPFS为8.0个月(95%CI:5.8个月～10.2个月),差异有统计学意义(P<0.001),而患者是否有T790M突变在ORR、DCR均无显著差异(P>0.05)。基因突变类型上,EGFR 19外显子缺失突变的患者mPFS为11.5个月,21外显子L858R突变患者mPFS为10....     

第三代EGFR-TKIs在晚期非小细胞肺癌中的遴选量化评估

目的:通过对奥希替尼、阿美替尼和伏美替尼进行量化评估,以期为医院遴选第三代表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)提供依据。方法:从有效性、药学特性、安全性、经济性和其他属性5个方面对第三代EGFR-TKIs进行评估。结果:奥希替尼、阿美替尼和伏美替尼的遴选量化评估最终分值分别为80.6,66.2,65.9分。结论:根据评分结果,医疗机构在引入第三代EGFR-TKIs治疗晚期非小细胞肺癌时,建议遴选顺序为奥希替尼＞阿美替尼＞伏美替尼,在药品调整时可酌情选择总分较低的药品调出。