Erlotinib-related uveitis during treatment for stage IV EGFR-mutated lung cancer

What happened, in summary

A 67-year-old woman who had never smoked was diagnosed with stage IV, T2aN1M1a non-small cell lung cancer carrying an EGFR L858R mutation. She began first-line erlotinib at 150 mg daily and had no previous or concurrent lung-cancer treatment.

Six weeks later, she developed malaise, subjective fever, blurred vision, and numerous dark floaters in both eyes. She was also experiencing an acne-like rash, nail-fold inflammation, and mild mouth inflammation from erlotinib. Eye examination showed bilateral acute anterior uveitis, with inflammatory cells in both anterior chambers but no retinal disease or loss of visual acuity.

Infectious and systemic inflammatory causes were excluded, and the uveitis was considered a rare erlotinib-related adverse effect. Erlotinib was temporarily withheld. She began dexamethasone eye drops every two hours and cyclopentolate three times daily. Within one week, the uveitis and systemic symptoms resolved.

Restaging CT at that point showed a partial response after six weeks of erlotinib. The drug was restarted at a reduced dose of 100 mg daily. Dexamethasone drops were tapered over six weeks. Later examinations found no recurrent uveitis, although dry-eye symptoms improved with lubricating drops.

At six months, the partial lung-cancer response was maintained and the eye inflammation had not returned. Her experience led to changes in local emergency-department education so similar visual symptoms in patients receiving erlotinib could be recognized and referred promptly.