Alectinib restored vision from an eye metastasis of ALK-positive lung cancer

What happened, in summary

A 64-year-old man sought urgent eye care after three days of reduced vision in his right eye. Examination found a large choroidal mass with fluid beneath the retina. He also reported a long-standing cough, major weight loss, and difficulty swallowing. Imaging and biopsy confirmed stage IV ALK-positive non-small cell lung cancer, described as poorly differentiated adenocarcinoma or adenosquamous carcinoma. Disease was present in the right choroid of the eye, liver, bone, and lymph nodes. He started alectinib on October 1, 2019. Within four weeks, the eye metastasis and associated retinal fluid had rapidly resolved, and his visual acuity improved from 6/24 to 6/9.5. He completed eight cycles over eight months. Apart from a mild facial rash and two early chest infections, treatment caused no major toxicity. His daily functioning improved, and he was able to drive again. The response lasted nearly eight months. In May 2020, the lung cancer progressed in the liver and bone and spread to the brain. Treatment was changed to lorlatinib, but his condition deteriorated quickly. He died on July 3, 2020, two months after progression. His right-eye vision remained stable and the choroidal metastasis did not return before his death.