Improving the prognosis of uveal melanoma

Chicago-About one-half of people diagnosed with uveal melanoma ultimately develop metastatic disease. A look at survival rates for patients with uveal melanoma indicate that not much has changed in the past several decades or even for the past 100-plus years.

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Nevertheless, there is good reason to be optimistic about the future considering the recent developments and ongoing research in this field, said Mary Beth Aronow, MD, at Ocular Oncology and Pathology 2016.

“It would be easy to have a gloomy outlook on where we stand with uveal melanoma and to feel we have not made progress,” said Dr. Aronow, assistant professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore. “However, I think we have made significant advances and we are working in exciting times.”

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Dr. Aronow discussed how developments in imaging, prognostication, clinical trials, and therapies combined with a collaborative effort are changing the landscape of ophthalmic oncology.

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Progress in the area of imaging has come with the availability of ultra-wide-field fundus imaging that allows for documentation of the appearance of the entire tumor and lesional response to treatment. Ultra-wide-field imaging systems are also available now for fluorescein angiography and for indocyanmice green angiography, which has been particularly useful for assessing choroidal tumors.

There have also been advances optical coherence tomography (OCT) technology, and the introduction of enhanced depth imaging systems in particular has been very helpful for characterizing the ultrastructural features of smaller tumors and indeterminate lesions, Dr. Aronow said.

Impact of OCT angiography

In addition, the advent of OCT angiography has provided ocular oncologists with yet another non-invasive technique for characterizing uveal melanomas.

In the area of prognostication, there have been advances based on information derived from assessments of both clinical and genetic features.

“Whether it is by looking at these tumors to understand how millimeter by millimeter, small increments in size affect the likelihood of the tumor to metastasize or whether it is taking a closer look at the chromosomes, genes, DNA, or RNA, we have gotten much better at predicting which uveal melanomas are likely to metastasize,” Dr. Aronow said.

“Whether you use one of the commercially available tests or work in a center that has particular expertise in one of the many prognostication techniques, the fact is that we can look at these tumors and tell with a high degree of certainty which are more likely to spread outside the eye,” he said.

The advances in prognostication have contributed to growth in clinical trial activity. Whereas a search for open studies of uveal melanoma that were actively recruiting patients would identify just two matches for the 10-year period from 1996 to 2006, 47 such studies were found during a search set to encompass the most recent decade.

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Dr. Aronow added there are also far more recently completed clinical trials than a decade ago, including adjuvant treatment trials that are aimed at preventing metastasis and treatment trials for patients whose uveal melanoma has metastasized.

Also encouraging is the fact that new targeted therapies are emerging.

“In an era when plaque brachytherapy, proton beam irradiation, and enucleation have been the mainstay of treatment, we are now seeing new small molecule inhibitors and immunotherapies,” Dr. Aronow said. “We are now seeing new small molecule inhibitors and immunotherapies, and these treatments have the potential to revolutionize the way we take care of our patients.”

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Dr. Aronow cited strong collaboration among researchers and clinicians as being the most important advance in uveal melanoma in the past decade.

She noted that it is reflected by such events as The First Eye Cancer Working Day held in 2015 with the theme “Working Together”, the development of a new universal language for tumor staging, and an ongoing exchange of ideas among all individuals with an interest in this field.

“We are one group of doctors working together to make headway in this disease and to help our patients with uveal melanoma,” she said.