Bevacizumab (Avastin) in the management of ocular metastasis
18 June 2012
Choroidal metastasis is the most common form of intraocular malignancies. It may occur in up to 10% of patients with systemic metastasis with almost half of the patients developing central nervous system disease. The most common primary sites of ocular metastasis are breast cancer in women and lung cancer in men. In most cases, these lesions tend to be small and asymptomatic and are not evaluated by an ophthalmologist. For symptomatic and larger lesions, external beam radiation offers an excellent alternative to save the eye and stabilize vision. Bevacizumab (Avastin), humanized monoclonal anti-body against vascular endothelial growth factor (VEGF) has shown promising results when used in the treatment of choroidal metastasis. 
Systemic or intravitreal injection of bevacizumab has resulted in complete and durable remission of choroidal metastasis from non-small cell lung cancer, colorectal cancer, breast cancer and kidney carcinoma. [2-6] However, Alasil T et al have reported a case of choroidal metastasis from renal cell carcinoma of clear cell type in a patient of 65 year old who had undergone radical nephrectomy 15 years back. Choroidal metastasis in this patient was non-responsive to intravitreal injection of bevacizumab.  Inherent resistance of clear cell type of renal cell carcinoma may be reason for this non-responsiveness to intracameral bevacizumab. 
Symptomatic choroidal metastasis from common tumor sites and histologies are effectively treated with systemic or intravitreal bevacizumab. Nevertheless, we should closely monitor for response in the symptomatic patients with choroidal metastasis especially from the tumors of less common and resistant histopathology.
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Competing interests: None declared
All India Institute of Medical Sciences, Ansarinagar, New Delhi - 110029
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