What are the treatment options for metastatic uveal melanoma?

Metastatic uveal melanoma is a type of cancer that begins in the eye and has also spread to other parts of the body:

• Melanomas are a type of cancer that begin in pigment-producing cells called melanocytes. Cancerous mutations cause these cells to grow in an uncontrolled way.
• Uveal refers to the location of melanocytes involved in uveal melanoma—the uvea, the middle part of the eye that includes the choroid, ciliary body, and iris.
• Metastatic refers to a cancer that has spread (metastasized) beyond its initial tumor to other locations in the body.

The liver is the most common location for metastatic uveal melanoma to spread to. Metastasis to the lungs, bones, and skin are also common, though this type of cancer can spread to nearly any location in the body.

There is no cure for metastatic uveal melanoma, but there are treatments that can help a person with this diagnosis live longer.

Treatment for metastatic uveal melanoma

Treatment for metastatic uveal melanoma is different for each person. It will typically involve:

• Treatments for the primary tumor in the eye.
• Treatments for cancer in other locations in the body where it has spread.

As with any cancer, your best source of information about diagnosis and treatment will be your healthcare providers. When talking to your healthcare providers, it can help to have a basic understanding of different treatments that may be discussed and how those treatments work.

Treatment may include a combination of the following:

Surgery

• This can include surgery to remove the primary tumor in the eye. This may require removing the entire eye and—depending on the size of the tumor—removing structures around the eye.
• Reconstructive surgery can improve appearance and function after removal of the eye or part of the eye.
• Surgery may also be used to remove metastatic tumors in other locations in the body, such as the liver.

Ablation therapy

• Ablation therapies work by destroying or removing abnormal tissues, like tumors. This may be a treatment option for treating cancer outside the eye, such as tumors in the liver, lungs, bones, or other places in the body.
• There are multiple types of ablation therapies, which use different methods to destroy tumors—heat (radiofrequency ablation and microwave ablation), extreme cold (cryoablation), and alcohol (percutaneous ethanol injection).

Radiation therapy

• Radiation therapy is the use of intense energy to destroy cancer cells and shrink tumors.
• There are several different types of radiation therapies that are used in the treatment of uveal melanoma, which direct radiation at the tumor in different ways.
• One example is brachytherapy, which involves the placement of a radioactive substance near or into the tumor. Different brachytherapy techniques can be used to treat tumors in the eye and the liver.
• Another example is external beam radiation, where a machine is used to carefully aim a beam of radiation at a tumor. This can be used to treat tumors in the eye as well as tumors in other locations.

Immunotherapy

• Immunotherapies are cancer drugs that help the body’s immune system detect and destroy cancer cells.
• The first treatment indicated specifically for metastatic uveal melanoma is a type of immunotherapy. It helps white blood cells called T cells recognize and destroy uveal melanoma cells. It can be used to treat people who are HLA-A*02:01 positive (a genetic variation that can be determined with a blood test).
• Other immunotherapies called immune checkpoint inhibitors have also been used to treat metastatic uveal melanoma in some cases. These drugs are approved for the treatment of other types of cancers, and may be used in combination with chemotherapy.

Chemotherapy

• Chemotherapy drugs contain powerful chemicals that act on fast-growing cells. Because cancer cells grow quickly, chemotherapy drugs can be useful in killing cancer cells or slowing the growth of cancer cells.
• Both regional chemotherapy and systemic chemotherapy may be used in the treatment of metastatic uveal melanoma.
• Regional chemotherapy is delivered directly to a tumor. This approach may be used to treat metastatic tumors in the liver that cannot be treated with surgery.
• Systemic chemotherapy refers to chemotherapy drugs that travel throughout the body to fight cancer cells. These are often given as an infusion into a vein. This is typically not the first approach to treating metastatic uveal melanoma and is only used in certain cases.

Discussing a treatment with a healthcare provider

Therapies to treat metastatic uveal melanoma are often used in combination with one another. Here are a few questions to ask your healthcare provider when discussing treatment for metastatic uveal melanoma:

• What is the name of each therapy being recommended?
• How does each therapy work? Why are different therapies used together?
• What is the goal of treating with this approach?
• What side effects can this treatment cause?
• Is there a risk of serious side effects? What will be done to monitor for side effects?
• What does this treatment cost?

Clinical trials

Other therapies for metastatic uveal melanoma are under development, and clinical trials for these therapies may need participants. If participating in a clinical trial is something that you are interested in, talk to your healthcare providers, who can advise you on what steps to take.