UM Cure Consortium members collaborated with distinguished ocular oncologists to publish a thorough, scientific and clinical, overview of uveal melanoma, focusing on patient-centered care.
This Nature Review paper summarizes the knowledge obtained from basic science and clinical experience, covering primary and metastatic uveal melanoma (UM). You can access the original paper here.
Although the main alterations that lead to UM lesions in the eye are known, how and when they arise are still questions that doctors are trying to get answers to. A better understanding of their sequence and consequences will allow to develop new drugs to effectively prevent or treat UM’s progression. UM is a very singular cancer in the sense it seems that it goes undetected by our immune system - the defense mechanism we have against infections and cancer cells. This is one of the reasons why immunotherapy, a class of drugs that has been highly effective in treating cutaneous melanoma, is less effective in treating UM.
Early detection remains the best approach for this disease, having ophthalmologists a crucial role in recognizing suspicious ocular moles and small UM lesions. Advances in the technologies used for diagnosing eye tumors might be of help in more challenging cases, allowing for faster diagnosis. Once diagnosed, the goals of the treatment are to prevent metastatic spread and to conserve the eye with useful vision. Treatment of the primary tumor (in the eye) is largely effective with current treatment available, being radiotherapy the most frequently employed. Unfortunately, even with conservative treatments, vision alterations may still occur. Recent advances in immunotherapy and chemotherapy have enhanced prospects to reduce tumour volume before administering localized eye treatment, with less associated vision threatening side-effects. New treatments are also being tested, such as laser treatments (photodynamic therapy) that will allow to reduce ocular side-effects, if shown effective in treating the tumor.
Prognostication (predicting if a patient will be affected by metastatic disease - spread of the cancer from the eye to other parts of the body) is rather accurate in UM. In fact, comparing with other cancers, in UM is possible to calculate the risk of metastasis very precisely. This is done by studying multiple factors such has the size and location of the tumor, the type of cells that are present, which mutations the tumor has, being the information processed by prognostication tools such as the Liverpool Uveal Melanoma Prognosticator Online (LUMPO).
The treatment of metastatic disease remains a challenge. It is currently advised to closely monitor patients with liver scans, since the liver is the most common site for metastasis. This surveillance should be tailored according to the risk of the patient developing metastatic disease. Several approaches are being studied, either through surgery (liver-directed therapies) or through systemic treatments.
The ultimate goal of UM treatment is to save vision, effectively treat metastases and, ultimately, save lives. Equally important, awareness is growing of the need to focus care on the patients’ needs, not only treating the disease but also providing better psychological support to patients and their families. These measures will improve the wellbeing of those affected by UM, regardless of outcome.