Targeting liver metastasis in uveal melanoma patients may increase survival compared with systemic chemotherapy
A new analysis suggests that therapies targeting the liver – the most common site of metastasis in uveal melanoma – increase average survival by a year. The study on the effectiveness of targeted treatment comes after decades of varying treatments with poor overall survival.
Researchers at the Sidney Kimmel Cancer Centre at Thomas Jefferson University (PA, USA) have compared survival rates of patients undergoing treatment for uveal melanoma with liver metastasis and found that treatment with liver-targeted therapy increases overall survival following metastasis by 12.5 months, compared with systemic chemotherapy alone. While the researchers have previously reviewed clinical factors predictive of metastasis, the current study aimed to analyze the success of different treatment modalities.
There is currently no FDA-approved treatment for metastatic uveal melanoma. The cancer – which affects the eye – is rare, comprising less than 5% of all melanomas. Although treatment of the primary tumor is generally successful, metastasis occurs in up to half of all patients; the liver is the most common site of metastasis and is involved in 90% of cases
This retrospective study reviewed treatments historically, over three time periods. Cohorts one, two and three were made up of patients who received treatment from 1971–1993, 1998–2007 and 2008–2017, respectively. 70% of patients in cohort one received systemic chemotherapy alone, while cohorts two and three received liver-directed treatments, sometimes in combination with systemic therapy.
Patients in cohort one survived an average of 5.3 months after liver metastasis, while for cohorts two and three this increased to 13.6 and 17.5 months, respectively. All patients in cohort one eventually died of metastatic uveal melanoma, only one patient survived to be censored in cohort two, however 78 patients were alive and censored in cohort three.
Doctors have tried various systemic treatments for metastatic uveal melanoma, including anti-angiogenics, kinase inhibitors and, more recently, immunotherapies. However, none of these have progressed to Phase III trials, their demonstrable efficacy insufficient to change standard practice.
As new treatment avenues such as immunotherapy emerge, the study’s authors are hopeful that combined therapies which include liver-directed treatment will provide much-needed improvements to prognosis.
“We believe that our study is one of the largest studies showing extended survival in uveal melanoma patients with liver metastasis,” commented Takami Sato (Thomas Jefferson University), one of the study’s authors. “We are also hoping that the addition of newly developed systemic therapies, especially immunotherapy, to liver-directed treatments will further increase the survival of patients with this devastating disease,” Sato concluded.
Seedor RS, Eschelman DJ, Gonsalves CF et al. An outcome assessment of a single institution’s longitudinal experience with uveal melanoma patients with liver metastasis. Cancers.12(1); 117; (2020);