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Molecular genomics guides targeted uveal melanoma therapy
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BOSTON — Uveal melanoma management is undergoing significant changes that enable improved survival for patients, improved globe retention and excellent visual acuity preservation, a speaker said here.
Such management is possible when targeted genomics are evaluated and direct surgical laser ablation that avoids radiotherapy is used, according to Timothy G. Murray, MD, MBA, who spoke on the topic at the American Society of Retina Specialists meeting.
“I believe that genomic profiling of our patients has been a game-changer,” Murray said.
In an update of a presentation of 50 cases of small uveal melanoma delivered at the ASRS meeting in 2014, Murray reported on the consecutive series of now 198 patients undertaken to evaluate the long-term outcomes of a microsurgical melanoma tumor ablation approach using micro-invasive vitrectomy surgery (MIVS), endolaser tumor ablation and fine-needle aspiration biopsy to direct personalized therapy.
All cases had increasing tumor size or increasing subretinal fluid and were confirmed by molecular genomic analysis. All cases were managed with a standardized surgical approach, including pars plana vitrectomy, membrane peeling, endolaser thermal tumor ablation and intravitreal triamcinolone acetonide.
Study results showed a decline in the apical height of the tumor from 1.9 mm to 1.4 mm, five patients had either persistence or progression of the exudative retinal detachment, and visual acuity improved to 20/50 or better in 95% of patients.
“[This] is important when you’re managing small tumors, that we don’t compromise visual acuity and anatomic function,” Murray said.
No patient in the series died of metastatic disease, and local tumor control was achieved in 195 of the patients.
“The three patients with non-local tumor control and progression all had tumor thickness greater than 2.8 mm. We had no infectious events, and the retinal detachment progressions appeared to be related to post-surgical inflammatory alterations,” he said. – by Patricia Nale, ELS
Reference:
Murray TG. Targeted uveal melanoma therapy: Extended follow-up of radiotherapy- sparing surgical ablation for small choroidal melanoma. Presented at: American Society of Retina Specialists 35th Annual Meeting, Aug. 11-15, 2017; Boston.
Disclosure: Murray reports he is a consultant for and has received honoraria from Alcon Surgical, and he is an investigator for and has received grant funding from Regeneron.