Abstract
There is no FDA-approved treatment for metastatic uveal melanoma (UM) and overall outcomes are generally poor for those who develop liver metastasis. We performed a retrospective single-institution chart review on consecutive series of UM patients with liver metastasis who were treated at Thomas Jefferson University Hospital between 1971–1993 (Cohort 1, n = 80), 1998–2007 (Cohort 2, n = 198), and 2008–2017 (Cohort 3, n = 452). In total, 70% of patients in Cohort 1 received only systemic therapies as their treatment modality for liver metastasis, while 98% of patients in Cohort 2 and Cohort 3 received liver-directed treatment either alone or with systemic therapy. Median Mets-to-Death OS was shortest in Cohort 1 (5.3 months, 95% CI: 4.2–7.0), longer in Cohort 2 (13.6 months, 95% CI: 12.2–16.6) and longest in Cohort 3 (17.8 months, 95% CI: 16.6–19.4). Median Eye Tx-to-Death OS was shortest in Cohort 1 (40.8 months, 95% CI: 37.1–56.9), and similar in Cohort 2 (62.6 months, 95% CI: 54.6–71.5) and Cohort 3 (59.4 months, 95% CI: 56.2–64.7). It is speculated that this could be due to the shift of treatment modalities from DTIC-based chemotherapy to liver-directed therapies. Combination of liver-directed and newly developed systemic treatments may further improve the survival of these patients.
Highlights
Uveal melanoma (UM) is rare, comprising less than 5% of all melanomas, it is the most common primary intraocular malignancy in adults [1,2]
19 patients, 0 patients, and 3 patients in the 1971–1993, 1998–2007, and 2008–2017 database, respectively, that were excluded from the study due to loss of follow-up and lack of survival information
We believe that our study is one of the largest, “real-world” data showing improvement of the outcomes of metastatic uveal melanoma (UM) patients with liver metastasis over the last 47 years
Summary
Uveal melanoma (UM) is rare, comprising less than 5% of all melanomas, it is the most common primary intraocular malignancy in adults [1,2]. Despite successful treatments of the primary tumor, up to 50% of affected patients will develop systemic metastasis, with the liver involved in up to 90% of those patients [4,5]. Our Ocular Oncology team at Wills Eye Hospital have previously published several large retrospective reviews evaluating clinical factors predictive of metastasis [10,11,12]. They found that patient age, ciliary body location, increasing tumor diameter, increasing tumor thickness, darkly pigmented tumor, and the presence of subretinal fluid, intraocular hemorrhage, or extraocular extension were correlated with increasing risk for metastasis [10]. The risk for metastasis and death increased 2-fold with each increasing tumor size category in the American Joint Committee on Cancer
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