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Metastatic uveal melanoma: The final frontier
Elina S Rantala1, Micaela M Hernberg2, Sophie Piperno-Neumann3
1Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4 C, PL 220, FI-00029, HUS, Helsinki, Finland.
Progress in Retinal and Eye Research
|January 9, 2022
Summary
Metastatic uveal melanoma remains a deadly challenge, with limited treatment options and poor survival rates. Advances in staging and new therapies offer hope, but further research is crucial for a cure.
Area of Science:
- Ophthalmology
- Oncology
- Genetics
Background:
- Primary intraocular uveal melanoma treatment has advanced, with identified driver genes and precise metastasis risk assessment.
- Despite progress, distant metastases occur in about half of patients, leading to death, with no consensus on managing disseminated disease.
- Metastatic uveal melanoma survival has seen little improvement, highlighting the need to address surveillance, staging, and treatment.
Purpose of the Study:
- To review the current state of metastatic uveal melanoma management, including surveillance, staging, and treatment options.
- To identify challenges and critical steppingstones towards curing metastatic uveal melanoma.
- To discuss recent therapeutic advances and their impact on overall survival.
Main Methods:
- Review of existing literature, including meta-analyses, on metastatic uveal melanoma.
- Analysis of surveillance methods (ultrasonography, MRI, CT) and their effectiveness.
- Examination of validated staging systems and their predictive components.
Main Results:
- Median overall survival for metastatic uveal melanoma is 10-13 months, with a near-zero cure rate.
- Hepatic ultrasonography and MRI show high sensitivity for metastasis detection; CT is essential for staging.
- Surgical treatment and newer therapies like tebentafusp have shown improved median overall survival in selected patients.
Conclusions:
- Curing metastatic uveal melanoma requires addressing surveillance, staging, and treatment standardization.
- Promoting research, controlled clinical trials, and identifying predictive factors are essential for progress.
- Harmonizing protocols and promoting dormancy of micrometastases are key to overcoming this deadly disease.
