Treatment of ocular metastasis with anti-VEGF: A literature review and case report

• Published in: Canadian journal of ophthalmology 2014-10, Vol.49 (5), p.458-463
• Main Authors: Augustine, Haley, MScOT, Munro, Monique, MD, Adatia, Feisal, MD, FRCSC, Webster, Marc, MD, PhD, FRCPC, Fielden, Michael, MD, FRCSC
• Format: Article
• Language: English
• Subjects: Aged; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab; Bone Neoplasms - drug therapy; Bone Neoplasms - secondary; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Carcinoma, Intraductal, Noninfiltrating - drug therapy; Carcinoma, Intraductal, Noninfiltrating - secondary; Choroid Neoplasms - drug therapy; Choroid Neoplasms - secondary; Female; Fluorescein Angiography; Humans; Internal Medicine; Intravitreal Injections; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Ophthalmology; Tomography, Optical Coherence; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - drug effects
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2014.06.008

Abstract Purpose This is the first case report where 1.25 mg intravitreal bevacizumab (IVB) correlated with choroidal mass resolution from metastatic breast cancer given concurrently with chemotherapy demonstrating, at best, disease stability in other organs. Study design Case report. Methods Upon confirmation of choroidal, liver and bone metastasis from breast carcinoma, a 72-year-old female received four intravitreal bevacizumab 1.25 mg injections based on the presence of subretinal and intraretinal fluid. Visual outcomes were analyzed by ophthalmologic evaluation, B-scan, fluorescein angiography, and optical coherence tomography. Results After 3 treatments of 1.25 mg intravitreal bevacizumab, visual acuity improved from 20/125 OD to 20/30 OD. These results were maintained for 5 months, after which a 4th IVB injection was given to try to further improve visual outcomes. Following this, complete resolution of the mass was observed with remaining pigmentary changes and vision improved to 20/25 one month following this. IVB was administered concurrently to systemic chemotherapy that demonstrated at best disease stability in metastases in other organs. Conclusion In this case 1.25 mg intravitreal bevacizumab proved to be a safe, effective and relatively easy treatment for choroidal metastasis from breast cancer. An important benefit of intravitreal bevacizumab therapy for choroidal metastasis is the ease of administration and minimal time commitment required as compared to other therapies. Further studies should be conducted to confirm the appropriate dosing and long-term outcomes of intravitreal bevacizumab to treat choroidal metastasis.