e21018 Background: Uveal melanoma is the most common primary ocular tumor in adults and accounts for 5% of all melanoma diagnoses in the United States. Approximately fifty percent of patients with uveal melanoma develop metastatic disease. The most frequent site of metastasis from UM is the liver (89 to 95% of the cases) and liver failure is the leading cause of death. To date, no systemic therapy has shown benefits in terms of overall survival (OS) in UM. Methods: We retrospectively analyzed clinical characteristics and aspects of response to systemic and local therapy of a cohort of 58 patients with UM who were treated in our institution from January of 2000 to December of 2017. Survival curves were calculated by Kaplan-Meier method and log-rank test. Results: Median age was 55y. 64% of the patients were female and 48,3% of them were caucasian. With a median follow-up time of 23 months, the median OS was 28,4 months. The median time between primary treatment and systemic relapse was 3.7 years. In 90% of the cases the liver was the unique site of progression. 12% patients had liver metastasectomy as local treatment, with OS of 102,3 months vs. 24,5 months ( p= 0,04) for no local treatment. 12% of the patients with liver methastasis perfomed regional treatment with intra-arterial chemotherapy (IAC) and 17% with chemoembolization (CE). The progression free survival (PFS) for regional treatment was 2.9 months (0,9-27 m); 4,25 months (0,9-27 m) for IAC and 2,9 months (0,9-27 m) for CE. There was no significant benefit in OS for locorregional treatment. As first line treatment, 29% of patients had chemotherapy, 10% had ipilimumab and 3,4% had anti-PD1. The median PFS for first line treatment was 2,49 months; 2 months for chemotherapy, 3,8 months for ipilimumab and 14 months for anti-PD1. The median PFS for second line treatment was 2,8 months and for third line was 2,3 months. There was no consistent clinical impact in OS for systemic treatment. Conclusions: The current systemic treatments available for cutaneous melanoma have limited efficacy in UM, so far none have yet proven a survival benefit. Locorregional therapies are relevant for patients with unresectable hepatic metastases. Resection of liver lesions in highly selected cases has the potential to improve patient outcomes, but the survival advantage may partially reflect patient selection.
Systematic review of liver directed therapy for uveal melanoma hepatic metastases