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Sapna Patel, Ross Kennmer Chapman, Yong Qin, Dan Gombos; Synchronous uveal melanomas responding to immune checkpoint blockade. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3629.
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© ARVO (1962-2015); The Authors (2016-present)
Uveal melanoma (UM) is a rare disease in which cancer cells derive from the melanocytes within the uveal tract of the eye. Although less than 4% of UM patients present with metastasis at diagnosis of primary ocular tumors, nearly half of UM patients will develop lethal liver metastases, and patients with metastatic UM have a median survival of approximately 6-8 months. Immunotherapy and targeted therapies have shown a great deal of promise in advanced cutaneous melanoma, but no systemic therapy exists to improve clinical outcomes in UM. Herein, we present two rare cases of patients with synchronous primary and metastatic UM responding to immune checkpoint inhibitor treatments.
These two UM patients are Caucasian men. They were treated with ipilimumab (3mg/kg every 3 weeks x 4 doses) in the frontline setting. After disease progression, they were then treated with pembrolizumab (2 mg/kg every 3 weeks.).
Both patients tolerated treatment with immune checkpoint blockade monotherapy well. After treatment with 4 cycles of ipilimumab, one patient demonstrated progression of disease while another demonstrated objective response. Second line systemic treatment with pembrolizumab resulted in objective clinical responses in the liver and disease control in the primary tumor in the eye. After less than 6 months, one gentleman developed disease progression in his primary and metastatic UM while the other patient demonstrated hepatic disease response for nearly 2 years.
The responses observed suggest that immunotherapy is feasible and safe, and may be useful for the treatment of a subgroup of metastatic UM patients, particularly those with synchronous primary tumors. This is the first report of treatment with immune checkpoint blockade in UM patients with synchronous primary and metastatic UM, with suggestion of different biology than metachronous disease. Further study of immunotherapy in UM patients with synchronous tumors is warranted. A third patient with synchronous disease treated with pembrolizumab monotherapy will be updated at the meeting.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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