Rapid vision improvement by using icotinib in a patient with bilateral choroidal metastases symmetrically from lung cancer.

INTRODUCTION: The metastases of lung cancer to bilateral choroids symmetrically and simultaneously are very rare. Almost all patients with choroid metastasis can be treated with external beam radiotherapy in order to increase quality of life and preserve vision. MATERIAL AND METHODS: We documented a case and studied the effect of icotinib on choroidal metastases in bilateral eyes simultaneously from pulmonary adenocarcinoma. RESULTS: A 49-year-old Chinese man presented with bilateral vision losing simultaneously for 4 weeks, it was as an initial presentation in the clinical. The examinations with ophthalmofundoscopy, ultrasonography, and fluorescein angiography showed the lesions in bilateral choroids, two solitary juxtapapillary yellow-white choroidal metastases inferior to the optic discs with bleeding. Positron emission tomography confirmed the choroidal metastases and further proved that it was from lung cancer with lymph nodes and multiple bone metastasis. The biopsy taken from the lung by bronchoscopy and needle biopsy from supraclavicular lymph nodes revealed the pulmonary adenocarcinoma with epithelial growth factor receptor mutation (exon 21). The patient was treated with oral icotinib (125 mg, three times a day, TID). Five days after starting icotinib therapy, the patient's visions were rapidly recovered. Two months after the treatment with icotinib, the choroidal metastases regressed to small lesions, and the visions were preserved to before. The lung tumor and other metastatic lesions were partly regressive. There was no evidence of recurrence for eye lesions at 15-months follow-up. After 17 months treating by icotinib, the patient presented headache and dizzy with multiple brain metastases determined by magnetic resonance imaging; however, the lesions of the choroidal metastases remained progressing-free. Almonertinib with radiotherapy were used to treat the brain metastases, and he is surviving with progress-free more than 2 years until now. CONCLUSION: Bilateral choroidal metastases from lung cancer symmetrically are very rare. Icotinib following by almonertinib was an alternative therapy for choroidal metastasis from non-small cell lung cancer with epithelial growth factor receptor mutation.

The Levels of TNF-α, Tissue Factor, and Coagulation Function in Rats with Pulmonary Hypertension and the Intervention Effect of Sildenafil Encapsulated by Targeted Nanocarriers.

Pulmonary hypertension (PAH) is a proliferative disease of pulmonary blood vessels, but the pathogenesis of pulmonary hypertension is still unclear. This article explores the role of tumor necrosis factor-α (TNF-α), tissue factor (TF), and coagulation function (CF) in the pathogenesis of PAH. PAH is often accompanied by vascular intima injury and muscular arterial media thickening. Coupled with the wide application of nanotargeted drugs in recent years, a targeted nanocarrier encapsulating sildenafil was prepared in this study. The particle size, PDI, zeta potential, drug loading, and encapsulation efficiency were 194.32 ± 17.31 nm, 0.28 ± 0.02, -6.34 ± 0.33, 24.61%, and 70.52%. The monocrotaline PAH rat model was constructed, and it was found that the levels of TNF-α, TF, and CF in the peripheral blood of PAH rats were abnormally increased. 30 PAH rats were randomly divided into 5 groups and injected with saline (NS group), sildenafil (sildenafil group), target the nanoempty carrier (TNC-E group), ordinary nanocarrier encapsulated sildenafil (CNC-sildenafil group), and targeted nanocarrier encapsulate sildenafil (TNC-sildenafil group). Compared with the NS group, the mean pulmonary artery pressure in the TNC-sildenafil group was lower (P < 0.05). Compared with the normal rat group, the pulmonary small blood vessel media thickness, TNF-α level, TF level, and the area of myocardial cells were increased in the NS group, sildenafil group, TNC-E group, and CNC-sildenafil group (P < 0.05). Compared with the NS group, the pulmonary small blood vessel media thickness, myocardial cell area, and the levels of TNF-α and TF in the TNC-sildenafil group were reduced (P < 0.05). Targeting nanocarrier encapsulation of sildenafil can obviously reduce the average pulmonary artery pressure in rats with pulmonary hypertension, improve pulmonary vascular media proliferation and myocardial hypertrophy, and restore the levels of TNF-α, TF, and CF to a normal state.