What happened, in summary

A man in his 70s developed worsening right-eye pain, visual disturbance, forehead swelling and pain in the left pelvis over 1 month. He had smoked about 5 cigarettes a day for approximately 50 years. Examination showed a protruding right eye and a tender mass over the right frontal bone.

Because his symptoms centered around the eye and forehead, doctors first considered an orbital lymphoma or meningioma. CT imaging then found a cavitary lesion in the right upper lung and another lesion in the left iliac bone. Biopsies of the lung and frontal mass confirmed metastatic lung adenocarcinoma. The cancer had spread to the right orbit, frontal skull and left iliac bone. Molecular testing identified a MET exon 14 skipping mutation, providing a target for treatment.

He first received palliative radiation therapy to the orbital and iliac lesions at a dose of 20 Gy over 5 treatments. His eye pain, visual problems, forehead swelling and pelvic pain improved quickly. He then started the MET-targeted medicine tepotinib at 500 mg daily.

After 2 months, the main lung lesion had decreased from about 53 × 33 mm to 36 × 24 mm, while the metastatic sites remained stable. He continued tepotinib without significant adverse effects and reported a better quality of life. Two months into treatment, he said the rapid relief of pain and swelling had helped him continue his daily activities and feel reassured.