Combination of intravitreal bevacizumab and systemic therapy for choroidal metastases from lung cancer: report of two cases and a systematic review of literature

Symptomatic choroidal metastasis (SCM) is an uncommon manifestation of lung cancer (LC). Treatment of SCM usually includes a combination of systemic therapy (chemotherapy and/or targeted therapy) for the primary tumor as well as local therapy (ocular radiation) for CM. Intravitreal bevacizumab (IV-Bev) is a newer modality being tried for local control of SCM. We describe here two patients with LC who presented with CM and were treated with IV-Bev. We performed a systematic literature review of previously reported patients with CM from LC who were treated with IV-Bev. Six reports (involving seven patients) in which IV-Bev was used as primary treatment modality for CM from LC were identified in the systematic literature review. A total of nine patients (seven previously reported and two index cases) were analyzed further. Along with individual case descriptions of index patients, pooled analysis of demographic profile, histology and outcomes with treatment (systemic and ocular) for the nine patients identified in this systematic review are described. A majority (n = 7) had non-small-cell lung cancer (NSCLC) histology, CM as presenting manifestation (n = 6) and unilateral ocular involvement (n = 8). IV-Bev was used in a dose of either 1.25 mg/cycle (n = 5) or 2.5 mg/cycle (n = 4) with number of cycles varying from 2 to 14 and duration between cycles varying from 2 to 8 weeks. Of the nine patients treated with IV-Bev as the primary ocular treatment modality, six (all non-squamous NSCLC) had favorable ocular response. No short-term ocular complications related to therapy were noted. We suggest that IV-Bev is a promising and safe alternative to ocular radiation for initial treatment of CM from non-squamous NSCLC. However, we recommend against using it for patients with small-cell lung cancer.