A Prospective Phase II Trial of Radioembolization for Treatment of Uveal Melanoma Hepatic Metastasis

Abstract

veal melanoma (UM) is the most common primary malignant intraocular tumor in adults with an incidence of 5.1 cases per million in the United States (1-3). Up to 50% of patients with UM develop metastatic disease (3). The liver is the primary site of metastasis in greater than 90% of patients, and less than 10% of patients are candidates for surgical resection due to multiplicity of tumors at the time of diagnosis (3). Currently, there are no effective systemic therapies for patients with metastatic UM. In general, without treatment, median overall survival (OS) following detection of hepatic metastases is reportedly less than 6 months, with a 1-year survival of 10%-15% (3). Most commonly, patient death is due to growth of hepatic metastases ultimately leading to hepatic failure. Therefore, stabilization of liver metastases is essential to prolonging OS for patients with metastatic UM. Transarterial catheter-directed therapies used to control the growth of UM hepatic metastases include immunoembolization, chemoembolization, and percutaneous hepatic perfusion (4-15). A few retrospective studies have also reported encouraging results following radioembolization (RE) of UM hepatic metastases (4-7). In 2009, a small multicenter trial reported a 1-year survival of 80% for patients with UM treated with RE (4). In 2011, a median OS of 10.0 months was reported for patients treated with RE following failure of both immunoembolization and chemoembolization (5). In addition, a larger retrospective trial reported a median OS of 12.3 months following RE of 71 patients with UM hepatic metastases (6). The purpose of our study was

Treatment of Metastatic Uveal Melanoma: Systematic Review

“…When combined with other therapies, such as immunotherapy (ipilimumab, nivolumab, pembrolizumab, or Il-2) or immunoembolization (IE), OS rises slightly, even reaching 26 months in the study by Levey et al [ 125 ], in which extreme values were also obtained with 95 and 120 months of survival in two patients. Values that are considerably different from the median were also found in the study by Gonsalves [ 127 ].…”

“…Treatment with SIRT offers a median OS at around 18 months, as first-line therapy, with very homogeneous results in the included studies [ 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 ]. When combined with other therapies, such as immunotherapy (ipilimumab, nivolumab, pembrolizumab, or Il-2) or immunoembolization (IE), OS rises slightly, even reaching 26 months in the study by Levey et al [ 125 ], in which extreme values were also obtained with 95 and 120 months of survival in two patients.…”

Yttrium‐90 radiation segmentectomy for hepatic metastases: A multi‐institutional study of safety and efficacy

“…Yttrium-90 ( 90 Y) radioembolization is a form of selective internal radiation therapy, which has been effective for unresectable hepatocellular carcinoma (HCC) and multifocal hepatic metastases. [17][18][19] With hepatic metastases, some practice patterns reserve radioembolization for large or multifocal tumors. As a result, radioembolization is considered most often in the salvage setting when surgical resection is not feasible, and systemic therapy options have been exhausted.…”

Molecular Insights and Emerging Strategies for Treatment of Metastatic Uveal Melanoma

“…This study demonstrated similar median OS (18.5 months and 19.2 months) and 1-year survival rate (60.9 and 69.6%) between the two groups, respectively. Interestingly, the stabilization of hepatic disease was achieved in 87.0% of participants in groups A versus 58.3% in group B [ 201 ]. In a recent single arm, open labeled, nonrandomized study, the combination of yttrium-90 microspheres and intravenous cisplatin was well tolerated in mUM, but it failed at demonstrating sustained disease control with a median PFS of 3 months and median OS of 10 months [ 202 ].…”