Incremental uveal tumor growth increases metastatic risk

With every millimeter of tumor thickening, risk for metastasis and death increases in patients with large uveal melanoma, Carol L. Shields, MD, said in a presentation at the Wills Eye Conference in Philadelphia.

The retrospective chart review spanned 7 years and included 1,311 patients with “large” uveal melanoma tumors at least 10 mm thick.

Shields and colleagues found an overall 7-year risk for metastasis of 52%. In contrast, smaller tumors 1 mm to 2 mm thick carry a 10-year risk for metastasis of 12%, and tumors 5 mm to 6 mm thick carry a 28% risk.

Carol L. Shields, MD
Carol L. Shields

“This is the most dangerous of the group,” Shields told Ocular Surgery News. “These large tumors are usually seen in older patients and mostly Caucasians. They are usually in the ciliary body, and they often have substantial subretinal fluid.”

Outcomes are “dismal,” she said. “Every millimeter they get thicker — 10 mm to 11 mm, 11 mm to 12 mm, 12 mm to 13 mm — it adds a greater risk for metastatic disease.”

All patients in the study were offered some form of adjuvant therapy, whether it was Sutent (sunitinib, Pfizer) or valproic acid, and survivability did improve, albeit less so in patients older than 60 years. Survivability doubled for patients aged 60 years or younger who received sunitinib, Shields said. New avenues of immunotherapy are under study as well.

“[Uveal melanoma] is not just an eye disease. It is more than that — it’s a systemic disease. We have to treat it as a systemic disease, not just an eye disease. So, we don’t just treat the eye. We’ve got to treat the whole body because these patients are at risk for tumor spread and death,” she said. – by Scott Buzby

Disclosure: Shields reports she serves on the science advisory boards of Aura Biosciences and Immunocore.

With every millimeter of tumor thickening, risk for metastasis and death increases in patients with large uveal melanoma, Carol L. Shields, MD, said in a presentation at the Wills Eye Conference in Philadelphia.

The retrospective chart review spanned 7 years and included 1,311 patients with “large” uveal melanoma tumors at least 10 mm thick.

Shields and colleagues found an overall 7-year risk for metastasis of 52%. In contrast, smaller tumors 1 mm to 2 mm thick carry a 10-year risk for metastasis of 12%, and tumors 5 mm to 6 mm thick carry a 28% risk.

Carol L. Shields, MD
Carol L. Shields

“This is the most dangerous of the group,” Shields told Ocular Surgery News. “These large tumors are usually seen in older patients and mostly Caucasians. They are usually in the ciliary body, and they often have substantial subretinal fluid.”

Outcomes are “dismal,” she said. “Every millimeter they get thicker — 10 mm to 11 mm, 11 mm to 12 mm, 12 mm to 13 mm — it adds a greater risk for metastatic disease.”

All patients in the study were offered some form of adjuvant therapy, whether it was Sutent (sunitinib, Pfizer) or valproic acid, and survivability did improve, albeit less so in patients older than 60 years. Survivability doubled for patients aged 60 years or younger who received sunitinib, Shields said. New avenues of immunotherapy are under study as well.

“[Uveal melanoma] is not just an eye disease. It is more than that — it’s a systemic disease. We have to treat it as a systemic disease, not just an eye disease. So, we don’t just treat the eye. We’ve got to treat the whole body because these patients are at risk for tumor spread and death,” she said. – by Scott Buzby

Disclosure: Shields reports she serves on the science advisory boards of Aura Biosciences and Immunocore.