Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma
Treatments for paraneoplastic optic neuropathy (PON), a tumor-related autoimmune disease, include immunosuppression, plasma exchange, and immunoglobulin therapies, as well as treatment of the underlying disease. Herein, we describe the clinical course of an older adult patient with PON whose loss of...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Ophthalmological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2021/2832021 |
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| author | Masaomi Kubota Nobumasa Tamura Takaaki Hayashi Euido Nishijima Haruhiko Yanagisawa Akira Kojima Tadashi Nakano |
| author_facet | Masaomi Kubota Nobumasa Tamura Takaaki Hayashi Euido Nishijima Haruhiko Yanagisawa Akira Kojima Tadashi Nakano |
| author_sort | Masaomi Kubota |
| collection | DOAJ |
| description | Treatments for paraneoplastic optic neuropathy (PON), a tumor-related autoimmune disease, include immunosuppression, plasma exchange, and immunoglobulin therapies, as well as treatment of the underlying disease. Herein, we describe the clinical course of an older adult patient with PON whose loss of vision improved after switching between epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatments for cancer. A 76-year-old woman, who had been treated with gefitinib for lung adenocarcinoma for two years, presented with acute bilateral visual disturbances. Her decimal best-corrected visual acuity (BCVA) was 0.3 in the right eye (RE) and 0.7 in the left eye (LE). Slit-lamp examination and funduscopy showed no abnormal findings. Two weeks later, her BCVA decreased to 0.2 in the RE and 0.01 in the LE. Goldman’s perimetry showed a defect in the lower nasal RE and extensive visual-field loss in the LE. Single-flash electroretinograms showed normal amplitudes. Magnetic resonance imaging revealed left optic neuritis and showed neither metastatic cancer nor multiple sclerosis. Pattern-reversal visual evoked potentials showed decreased P100 amplitudes in both eyes (BE). Based on a diagnosis of PON from clinical findings, methylprednisolone pulse treatment was administered. However, her BCVA became no light perception in BE two months after the first visit. Because the tumor tissue was found to be positive for the EGFR T790M resistance mutation by bronchoscopy, the EGFR-TKI treatment was changed to osimertinib, decreasing the size of the lung cancer lesions. Her BCVA improved to hand motion in BE. Her final BCVA was 0.01 in the RE, counting fingers 10 cm in the LE. She died at the age of 79 years. To our knowledge, no reports have shown improvement in BCVA in patients with PON after changing EGFR-TKI treatments. This report indicates that some patients may develop severe visual dysfunction without early treatment for the primary tumor. |
| format | Article |
| id | doaj-art-94436c52c0fe4419828426c287053812 |
| institution | Kabale University |
| issn | 2090-6722 2090-6730 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Ophthalmological Medicine |
| spelling | doaj-art-94436c52c0fe4419828426c2870538122025-02-03T05:44:44ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302021-01-01202110.1155/2021/28320212832021Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung AdenocarcinomaMasaomi Kubota0Nobumasa Tamura1Takaaki Hayashi2Euido Nishijima3Haruhiko Yanagisawa4Akira Kojima5Tadashi Nakano6Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, JapanDepartment of Respiratory Medicine, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, JapanDepartment of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, JapanDepartment of Ophthalmology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, JapanDepartment of Respiratory Medicine, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, JapanDepartment of Respiratory Medicine, Katsushika Medical Center, The Jikei University School of Medicine, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, JapanDepartment of Ophthalmology, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo 105-8461, JapanTreatments for paraneoplastic optic neuropathy (PON), a tumor-related autoimmune disease, include immunosuppression, plasma exchange, and immunoglobulin therapies, as well as treatment of the underlying disease. Herein, we describe the clinical course of an older adult patient with PON whose loss of vision improved after switching between epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) treatments for cancer. A 76-year-old woman, who had been treated with gefitinib for lung adenocarcinoma for two years, presented with acute bilateral visual disturbances. Her decimal best-corrected visual acuity (BCVA) was 0.3 in the right eye (RE) and 0.7 in the left eye (LE). Slit-lamp examination and funduscopy showed no abnormal findings. Two weeks later, her BCVA decreased to 0.2 in the RE and 0.01 in the LE. Goldman’s perimetry showed a defect in the lower nasal RE and extensive visual-field loss in the LE. Single-flash electroretinograms showed normal amplitudes. Magnetic resonance imaging revealed left optic neuritis and showed neither metastatic cancer nor multiple sclerosis. Pattern-reversal visual evoked potentials showed decreased P100 amplitudes in both eyes (BE). Based on a diagnosis of PON from clinical findings, methylprednisolone pulse treatment was administered. However, her BCVA became no light perception in BE two months after the first visit. Because the tumor tissue was found to be positive for the EGFR T790M resistance mutation by bronchoscopy, the EGFR-TKI treatment was changed to osimertinib, decreasing the size of the lung cancer lesions. Her BCVA improved to hand motion in BE. Her final BCVA was 0.01 in the RE, counting fingers 10 cm in the LE. She died at the age of 79 years. To our knowledge, no reports have shown improvement in BCVA in patients with PON after changing EGFR-TKI treatments. This report indicates that some patients may develop severe visual dysfunction without early treatment for the primary tumor.http://dx.doi.org/10.1155/2021/2832021 |
| spellingShingle | Masaomi Kubota Nobumasa Tamura Takaaki Hayashi Euido Nishijima Haruhiko Yanagisawa Akira Kojima Tadashi Nakano Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma Case Reports in Ophthalmological Medicine |
| title | Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma |
| title_full | Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma |
| title_fullStr | Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma |
| title_full_unstemmed | Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma |
| title_short | Vision Improvement after Osimertinib Treatment in Paraneoplastic Optic Neuropathy Associated with Lung Adenocarcinoma |
| title_sort | vision improvement after osimertinib treatment in paraneoplastic optic neuropathy associated with lung adenocarcinoma |
| url | http://dx.doi.org/10.1155/2021/2832021 |
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