Stage IV NSCLC with choroidal metastasis responding to intravitreal bevacizumab

What happened, in summary

This 50-year-old woman had non-small cell lung carcinoma diagnosed in November 2005 and had been receiving systemic carboplatin, paclitaxel, and bevacizumab for 8 months. In February 2007, she was referred for loss of vision, pain, and visual distortion in the right eye. Vision in that eye was 20/40. Eye examination showed a light-orange subretinal mass near the fovea, without retinal detachment. Ultrasonography measured the choroidal mass at 8.8 × 7.5 mm at the base, with a maximal elevation of 1.74 mm. The finding was consistent with choroidal metastasis from lung cancer, making this a Stage IV metastatic lung cancer story with spread to the eye. Her team treated the ocular metastasis directly by injecting bevacizumab into the right eye. She received five intravitreal injections of 2.5 mg each over 7 months. Pain disappeared after the third injection, visual distortion decreased, and vision improved to 20/20. Fundus examination showed tumor regression. By January 2008, about 10 months after starting intravitreal treatment, B-scan ultrasound could no longer detect the tumor, the choroid had normal thickness, and fluorescein angiography showed a scar without an active mass. No secondary reactions were reported. The documented outcome was a complete local response of the choroidal metastasis, while the broader systemic lung cancer course was not detailed beyond the ongoing chemotherapy and bevacizumab background. This distinction is clinically important because eye-directed therapy relieved symptoms and cleared the visible ocular lesion, but it should not be confused with proof that all lung cancer throughout the body had disappeared.