The Impact of Intravitreal Bevacizumab Therapy on Choroidal Melanoma

Lima, Breno R.; Schoenfield, Lynn; Singh, Arun D.

doi:10.1016/j.ajo.2010.08.040

Cited by 28 publications

(23 citation statements)

References 10 publications

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“…However, in both patients, tumors demonstrated growth following the injections: at the time of enucleation, one tumor had increased in size by 31% while the tumor in the second eye increased by 26%. This is consistent with a prior study that demonstrated continuous progression of uveal melanoma in eyes treated with multiple anti-VEGF injections for presumed choroidal neovascular membrane [8]. …”

Section: Discussionsupporting

confidence: 81%

Growth of Uveal Melanoma following Intravitreal Bevacizumab

et al. 2016

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Purpose: Typically treatment of large melanomas (by Collaborative Ocular Melanoma Study criteria) is restricted to enucleation, due to size constraints for plaque brachytherapy. Because primary and metastatic uveal melanoma cells are inhibited by bevacizumab (an anti-vascular endothelial growth factor), this prospective study evaluated the impact of intravitreal bevacizumab on large uveal melanomas that were destined for enucleation. Size reduction by bevacizumab would potentially salvage these eyes by making them eligible for treatment with plaque brachytherapy. Procedures: Two patients with large uveal melanoma were each treated with one intravitreous injection of bevacizumab (1.25 mg/0.05 mL). Results: Both tumors displayed paradoxical growth 1 week following the injection, with confirmed growth 1 week later (increase from baseline of 1.1 mm in one eye and 3.1 mm in the other eye). Both eyes were enucleated and monosomy 3 and vasculogenic mimicry patterns were identified in both tumors. At 9 years follow-up, both patients were alive and metastasis free. Conclusion: These patients demonstrate that neoadjuvant intravitreous bevacizumab does not decrease the size of large uveal melanomas and may, in fact, result in their paradoxical growth. This observation supports a cautious approach in the use of intravitreous bevacizumab for uveal melanoma, particularly in the neoadjuvant setting.

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Section: Discussionsupporting

confidence: 81%

Growth of Uveal Melanoma following Intravitreal Bevacizumab

et al. 2016

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“…This phenomenon has also been suggested after transpupillary thermotherapy, where residual tumor cells can continue to grow along the path of least resistance and thus cause recurrence, [19][20][21] and recently, it has been observed after multiple intravitreal injections of bevacizumab, describing also a closure of the intrinsic vascularity with overlying and intratumoral fibrosis. 22 In Case 5, the biopsy trauma could also have contributed to the fibrosis seen in the pathology; it could also have contributed to the invasion into the sclera and optic nerve. However, the biopsy site was at an edge away from the optic nerve, and in Case 4, the only previous intervention was the PDT. In Case 5, the monoclonal antibodies S100 and HMB45 against melanoma stained negatively.…”

Section: Discussionmentioning

confidence: 96%

Clinical and Histopathologic Findings After Photodynamic Therapy of Choroidal Melanoma

Canal-Fontcuberta¹,

Salomão²,

Robertson³

et al. 2012

Retina

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“…Other combined treatments have included photodynamic therapy,15 periocular triamcinolone acetonide,16 and local resection 17,18. More recently, systemic and local treatment with angiogenic inhibitors have been investigated 19,20…”

Section: Introductionmentioning

confidence: 99%

Intravitreal bevacizumab combined with plaque brachytherapy reduces melanoma tumor volume and enhances resolution of exudative detachment

Houston¹,

Shah²,

Decatur³

et al. 2013

OPTH

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BackgroundThe purpose of this study was to evaluate intravitreal bevacizumab as an adjuvant treatment to plaque brachytherapy in the treatment of choroidal melanoma.MethodsThis was a retrospective, consecutive study of 124 patients treated from 2007 to 2009 for choroidal melanoma with plaque brachytherapy. Patients were treated with I-125 plaque brachytherapy with 2 mm margins and 85 Gy to the tumor apex. Consecutive patients were injected intravitreally with 2.5 mg/0.1 mL bevacizumab at a site away from the primary tumor and immediately following plaque removal. Choroidal melanomas were observed using indirect ophthalmoscopy, wide-angle photography, and ultrasound. The main outcome measures were tumor volume, resolution of exudative retinal detachment, and visual acuity.ResultsOne hundred and twenty-four patients met our inclusion criteria and were included in the analysis. The mean patient age was 65.7 years, and the mean apical tumor height was 4.0 ± 2.7 mm and basal diameter was 12.7 ± 3.0 mm. Mean follow-up was 24 months. Prior to treatment, 100% of tumors had exudative retinal detachment, and pretreatment visual acuity was 20/55 (median 20/40). Tumor control was 100%, metastasis was 0% at last follow-up, and 89.8% had complete resolution of exudative retinal detachment, with a mean time to resolution of 3.36 months. At one month, 43% had complete resolution of exudative retinal detachment, which increased to 73% at 4 months. Visual acuity was 20/62 (median 20/40) at 4 months, with stabilization to 20/57 (median 20/40) at 8 months, 20/56 (median 20/30) at 12 months, and 20/68 (median 20/50) at 24 months. Tumor volume following combined therapy was shown to be reduced by 22.2% at 3 months, 28.9% at 6 months, 39.3% at 12 months, and 52.2% at 24 months (all P < 0.001). All patients tolerated the procedure well without systemic side effects.ConclusionIntravitreal bevacizumab may be used as an adjuvant agent following plaque brachytherapy. Treated choroidal melanomas show reduction in tumor volume as well as resolution of exudative retinal detachments.

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The Impact of Intravitreal Bevacizumab Therapy on Choroidal Melanoma

Cited by 28 publications

References 10 publications

Growth of Uveal Melanoma following Intravitreal Bevacizumab

Growth of Uveal Melanoma following Intravitreal Bevacizumab

Clinical and Histopathologic Findings After Photodynamic Therapy of Choroidal Melanoma

Intravitreal bevacizumab combined with plaque brachytherapy reduces melanoma tumor volume and enhances resolution of exudative detachment

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