Abstract
Simple SummaryContrary to other cancers, treatment of human uveal malignant melanoma metastases has not evolved sufficiently remaining as a great challenge in the field of ocular oncology. Although uveal melanoma is effectively controlled at the local level, the diagnosis of systemic disease in these patients makes its prognosis fatal, with survival rates of around 4–8 months. In this manuscript, we performed a systematic review studying comprehensively all the different treatment types for metastatic uveal melanoma disease in the last 40 years. We truly believe that our work shows a global vision of the situation, placing the reader in a concise and orderly manner in perspective of the current state of the subject.Introduction: More than 50% of patients with uveal melanoma end up developing metastases. Currently, there is no standard first-line treatment that facilitates proper management of the metastatic disease. Methods: A systematic review of the last 40 years in PubMed with an exhaustive and strict selection of studies was conducted, in which the unit of measurement was overall survival (OS) expressed in Kaplan–Meier curves or numerically. Results: After the selection process, 110 articles were included. Regional therapies, such as intra-arterial liver chemotherapy (OS: 2, 9–22 months), isolated liver perfusion (OS: 9, 6–27, 4 months), or selective internal radiation therapy (OS: 18 months in monotherapy and 26 months in combination with other therapies) showed some superiority when compared to systemic therapies, such as chemotherapy (OS: 4, 6–17 months), immunotherapy (OS: 5–19, 1 month), immunosuppression (OS: 11 months), or targeted therapy (OS: 6–12 months), without being significant. Conclusions: The results of this review suggest that there are no important differences in OS when comparing the different current treatment modalities. Most of the differences found seem to be explained by the heterogenicity of the different studies and the presence of biases in their design, rather than actual extensions of patient survival.
Highlights
More than 50% of patients with uveal melanoma end up developing metastases
We examined the effectiveness of current treatment regimens for the management of metastatic uveal melanoma (UM) and their benefits on the survival of these patients
Unlike its cutaneous counterpart, UM tends to be characterized by chemoresistance, as shown by the average survival rates provided by this review, which range from 4.6 to 17 months [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]
Summary
More than 50% of patients with uveal melanoma end up developing metastases. There is no standard first-line treatment that facilitates proper management of the metastatic disease. Results: After the selection process, 110 articles were included. Regional therapies, such as intra-arterial liver chemotherapy (OS: 2, 9–22 months), isolated liver perfusion (OS: 9, 6–27, 4 months), or selective internal radiation therapy (OS: 18 months in monotherapy and 26 months in combination with other therapies) showed some superiority when compared to systemic therapies, such as chemotherapy (OS: 4, 6–17 months), immunotherapy (OS: 5–19, 1 month), immunosuppression (OS: 11 months), or targeted therapy (OS: 6–12 months), without being significant. Despite the relatively good response of the primary UM to treatment, almost 50% of patients will develop metastatic disease. Long-term follow-up of treated patients reveals metastases in
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