Bevacizumab, an anti-angiogenic agent, has gained widespread use in ophthalmology for the treatment of neovascular conditions, such as age-related macular degeneration. Targeting angiogenesis has been proposed as a potential therapy for different kinds of malignancies, by limiting supply of oxygen and nutrients, and consequently tumour growth and metastasis. Bevacizumab has been approved by the US Food and Drug Administration, along with chemotherapy, for the treatment of metastatic colorectal carcinoma and non-small cell lung cancer. Nevertheless, a beneficial effect in the treatment of choroidal melanoma has yet to be demonstrated, despite elevated levels of vascular endothelial growth factor (VEGF). However, bevacizumab might have a role in the management of complications of radiation therapy.
KeywordsBevacizumab, choroidal melanoma, optic neuropathy, radiation retinopathy, vascular endothelial growth factor (VEGF) Disclosure: The authors have no conflicts of interest to declare. The impact of intravitreal bevacizumab as a primary therapy for choroidal melanoma and its role in the management of complications (e.g., radiation retinopathy) from established therapies (e.g., brachytherapy) will be discussed here. Results from animal models, in which bevacizumab has been used either systemically or intravitreally, will be reviewed. Current clinical trials looking at the administration of intravitreal or systemic anti-VEGF agents for choroidal melanoma will be summarised.
Treatment of Primary TumourIntravitreal bevacizumab, along with other anti-VEGF agents, has gained widespread use in ophthalmology over the last few years for the treatment of neovascular diseases, such as age-related macular degeneration, central retinal vein occlusion, proliferative diabetic retinopathy and macular oedema. It has been shown to reduce neovascular activity and vascular permeability in ocular tissues. It is that of a 55-year-old woman who presented for further investigation of a peripapillary choroidal lesion presumed to be an idiopathic choroidal neovascular membrane, and who was treated with five intravitreal injections of bevacizumab at monthly intervals.Choroidal melanoma has intrinsic vessels and commonly has associated subretinal fluid. Bevacizumab may transiently diminish tumour vasculature and permeability, reducing the subretinal fluid.However, subretinal fluid resolution may be misleading in this scenario and the tumour may to continue to grow.
8In the absence of studies documenting the efficacy of bevacizumab for the treatment of choroidal melanoma, caution is advised in the use of this drug as a sole treatment modality.
Management of ComplicationsSince the Collaborative ocular melanoma study (COMS), therapy for medium-sized choroidal melanomas has shifted from enucleation to plaque brachytherapy, as the survival rate has been found to be similar.
7Radiation retinopathy, optic neuropathy, iris neovascularisation and neovascular glaucoma are potential complications of plaque