A regressed choroidal metastasis during EGFR-targeted lung cancer treatment

What happened, in summary

A 49-year-old Asian Indian woman sought an eye examination after one month of flashing lights in her right eye. Six months earlier, she had been diagnosed with biopsy-proven stage IV primary lung adenocarcinoma carrying an EGFR exon 19 deletion. The cancer had spread to the liver, bones, and central nervous system. She received two cycles of carboplatin and pemetrexed and had taken oral erlotinib for six months.

Her visual acuity remained 20/20 in both eyes. Examination of the right retina found a small, dome-shaped brown lesion in the choroid with surrounding pigment changes. Imaging showed minimal choroidal thickening without subretinal fluid or the features expected in an active lesion. The appearance was considered consistent with a previously active choroidal metastasis that had regressed during systemic treatment. The left eye was normal.

Because the ocular lesion was inactive and her vision was preserved, no eye-directed radiation, laser treatment, or surgery was needed. Observation and regular follow-up were recommended, together with prompt reassessment for any visual loss. The clinicians considered erlotinib the likely main contributor to regression because of the EGFR exon 19 deletion and the six-month treatment duration, while acknowledging that the earlier platinum-based chemotherapy may also have helped. Her case reflects a favorable response at a rare metastatic site while systemic treatment for stage IV lung cancer continued.