Control of Intraocular Metastases of ALK-Rearranged Non-Small Cell Lung Cancer with Sequential Anaplastic Lymphoma Kinase Tyrosine Kinase Inhibitors: A Report of 2 Cases and Review of the Literature.

Anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC), which accounts for 2-7% of all lung cancer cases, may exhibit atypical metastatic patterns, including ocular involvement. Although rare, intraocular metastases can severely impact a patient's quality of life. While traditional treatments have primarily focused on local therapies, ALK tyrosine kinase inhibitors (TKIs) have emerged as a promising systemic alternative. A review of the literature supports the efficacy of ALK TKIs in managing intraocular metastases of ALK-rearranged NSCLC, with outcomes paralleling those observed systemically. In this report, we present two unique cases illustrating that intraocular metastasis, like systemic lesions, can respond to second and third-generation ALK TKIs even after developing resistance to first- and second-generation agents. This not only affirms the efficacy of ALK TKIs in managing intraocular metastasis, but also represents a potential strategy to improve long-term control of these metastases while postponing the need for local therapies. Overall, integrating systemic ALK TKI therapy with ophthalmological care can help preserve vision and improve the quality of life of these patients.