■转移性葡萄膜黑色素瘤(mUM)是一种难以治疗的疾病。肝脏是大多数患者的主要转移部位,尽管葡萄膜黑色素瘤在晚期疾病中广泛传播。FDA批准的唯一用于转移性葡萄膜黑色素瘤的免疫治疗药物是HLA-A02:01限制性双特异性T细胞接合药物,Tebentafusp.已经尝试了检查点抑制剂策略和组合方法,但取得了一些有限的成功。我们描述了我们在明尼苏达大学治疗患者的经验。
■如果有活检证实的mUM,则包括患者。确定了二十五(25)名符合标准的患者。回顾了医疗记录,并提取了患者基线特征和对治疗反应的数据。
■从局部治疗到眼部转移的中位时间为14.2个月(IQR;9.3-22.0),92%的患者的第一个转移部位是肝脏。两名患者(8%)未接受转移性疾病的全身治疗或放射治疗。23例(92%)患者接受了全身治疗,13名患者(52%)接受ipilimumab-nivolumab作为一线治疗,而4例患者(16%)接受派姆单抗治疗。显示了通过在活检证实诊断的6个月内接受全身治疗和放射疗法治疗的标志性生存分析。20例患者(80%)在mUM诊断后6个月内接受了全身治疗。13例患者(52%)在mUM诊断后6个月内接受了肝定向放射治疗。
■在我们的队列中,在mUM诊断后6个月内接受转移性疾病治疗的患者没有总体生存获益,与那些后来选择或根本不接受治疗的人相比。在一部分mUM患者中,ipilimumab和nivolumab具有显着的临床活性,与先前的研究一致,转移性PD-L1阳性肿瘤与延长生存期相关。
UNASSIGNED: Metastatic uveal melanoma (mUM) is a difficult to treat disease. The liver is the primary site of metastasis in most patients, though uveal melanoma spreads widely in advanced disease. The only FDA approved immunotherapy medication for metastatic uveal melanoma is the HLA-A02:01 restricted bispecific T cell engager drug, Tebentafusp. Checkpoint inhibitor strategies and combination approaches have been tried with some limited success. We describe our experience treating patients at the University of Minnesota.
UNASSIGNED: Patients were included if they had biopsy-confirmed mUM. Twenty-five (25) patients meeting the criteria were identified. Medical records were reviewed and data extracted for patient baseline characteristics and response to treatments.
UNASSIGNED: Median time to metastasis from the time of local therapy to the eye was 14.2 months (IQR; 9.3-22.0), and first site of metastasis was liver in 92% of patients. Two patients (8%) did not receive systemic therapy or radiation therapy for metastatic disease. Twenty-three (92%) patients received systemic therapy, 13 patients (52%) received ipilimumab-nivolumab as the first-line, while 4 patients (16%) received pembrolizumab. Landmark survival analysis by receipt of systemic therapy and radiation therapy treatments within 6 months of biopsy confirmed diagnosis is shown. Twenty patients (80%) received systemic therapy within 6 months of mUM diagnosis. Thirteen patients (52%) received liver directed radiation therapy within 6 months of mUM diagnosis.
UNASSIGNED: Within our cohort, there was no overall survival benefit for patients receiving treatment of metastatic disease within 6 months of mUM diagnosis, versus those electing later or no treatment at all. There was remarkable clinical activity of ipilimumab and nivolumab in a subset of patients with mUM, in agreement with prior studies, and metastatic PD-L1 positive tumors were associated with a prolonged survival.