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Brănişteanu DE, Porumb-Andrese E, Porumb V, Stărică A, Moraru AD, Nicolescu AC, Zemba M, Brănişteanu CI, Brănişteanu G, Brănişteanu DC. New Treatment Horizons in Uveal and Cutaneous Melanoma. Life (Basel) 2023; 13:1666. [PMID: 37629523 PMCID: PMC10455832 DOI: 10.3390/life13081666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Melanoma is a complex and heterogeneous malignant tumor with distinct genetic characteristics and therapeutic challenges in both cutaneous melanoma (CM) and uveal melanoma (UM). This review explores the underlying molecular features and genetic alterations in these melanoma subtypes, highlighting the importance of employing specific model systems tailored to their unique profiles for the development of targeted therapies. Over the past decade, significant progress has been made in unraveling the molecular and genetic characteristics of CM and UM, leading to notable advancements in treatment options. Genetic mutations in the mitogen-activated protein kinase (MAPK) pathway drive CM, while UM is characterized by mutations in genes like GNAQ, GNA11, BAP1, EIF1AX, and SF3B1. Chromosomal aberrations, including monosomy 3 in UM and monosomy 10 in CM, play significant roles in tumorigenesis. Immune cell infiltration differs between CM and UM, impacting prognosis. Therapeutic advancements targeting these genetic alterations, including oncolytic viruses and immunotherapies, have shown promise in preclinical and clinical studies. Oncolytic viruses selectively infect malignant cells, inducing oncolysis and activating antitumor immune responses. Talimogene laherparepvec (T-VEC) is an FDA-approved oncolytic virus for CM treatment, and other oncolytic viruses, such as coxsackieviruses and HF-10, are being investigated. Furthermore, combining oncolytic viruses with immunotherapies, such as CAR-T cell therapy, holds great potential. Understanding the intrinsic molecular features of melanoma and their role in shaping novel therapeutic approaches provides insights into targeted interventions and paves the way for more effective treatments for CM and UM.
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Affiliation(s)
- Daciana Elena Brănişteanu
- Department of Medical Specialties (III)-Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Railway Clinical Hospital, 700506 Iasi, Romania;
| | - Elena Porumb-Andrese
- Department of Medical Specialties (III)-Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Railway Clinical Hospital, 700506 Iasi, Romania;
| | - Vlad Porumb
- Department of Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Military Emergency Clinical Hospital “Dr. Iacob Czihac”, 700506 Iasi, Romania
| | | | - Andreea Dana Moraru
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | | | - Mihail Zemba
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | | | - George Brănişteanu
- “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.I.B.); (G.B.)
| | - Daniel Constantin Brănişteanu
- Railway Clinical Hospital, 700506 Iasi, Romania;
- Department of Ophthalmology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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Medek S, Correa ZM, Huth B, Takiar V. Early treatment and toxicity outcomes for small posterior uveal melanomas treated using custom loaded eye plaques. Front Med (Lausanne) 2023; 10:1055141. [PMID: 37215721 PMCID: PMC10196105 DOI: 10.3389/fmed.2023.1055141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Iodine-125 loaded Collaborative Ocular Melanoma Study plaques can achieve excellent tumor control for patients diagnosed with uveal melanomas. Our ocular cancer team hypothesized that use of novel, partially loaded COMS plaques could ease and improve accurate plaque placement during treatment of small, posterior tumors while providing equivalent tumor control. Materials/methods Records of 25 patients treated with custom plaques were compared to 20 patients treated with fully loaded plaques, who had received treatment prior to our institution's adopting the use of these partial plaques. Tumors were matched with regards to location and dimensions as measured by the ophthalmologist. Retrospective analysis of dosing parameters, tumor control and toxicity outcomes were performed. Results There were no cancer related deaths, local recurrences or metastases in either cohort at an average follow up of 24 months for patients treated with custom plaques and 60.7 months for patients treated with fully loaded plaques. No statistically significant difference was found in regards to post-operative development of cataracts (χ2 = 0.76) or radiation retinopathy (χ2 = 0.22). Patients treated with custom loaded plaques noted significantly less clinical visual loss (χ2 = 0.006) and were more likely to have vision preserved at ≥20/200 (χ2 = 0.006). Conclusion Treatment of small, posterior uveal melanomas with partially loaded COMS plaques results in equivalent survival and recurrence outcomes as treatment with fully loaded plaques, while exposing the patient to less radiation. Additionally, treatment with partially loaded plaques reduces the incidence of clinically significant visual loss. These promising early results support the use of partially loaded plaques in well-selected patients.
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Affiliation(s)
- Sara Medek
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
| | - Zelia M. Correa
- Ocular Oncology, Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL, United States
| | - Brad Huth
- Department of Radiation Oncology, St. Elizabeth’s Hospital, Edgewood, KY, United States
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, United States
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Hauzinger JA, Blatsios G, Haas G, Zehetner C, Velez-Escola L, Nowosielski Y, Seifarth C, Rauchegger T, Haider B, Bechrakis NE. Proton beam radiation for iris melanoma: case series and review of literature. BMJ Open Ophthalmol 2022; 6:e000683. [PMID: 35018306 PMCID: PMC8705205 DOI: 10.1136/bmjophth-2020-000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/27/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Purpose of this study is to analyse the visual outcomes, the complication and eye retention rate as well as tumour control data of patients treated with proton beam radiation therapy (PBRT) for iris melanoma. Methods Retrospective case series and review based on patients’ records. All tumours were categorised according to the American Joint Committee of Cancer staging criteria for primary iris melanoma und underwent either sectorial or whole anterior segment PBRT. Results Thirteen cases were identified of which five received PBRT of the whole anterior segment and eight received sectorial PBRT. Local tumour control after a mean follow-up of 25 months was 92%. Complications after PBRT included cataract (46%), secondary glaucoma (31%), superficial keratitis (15%) and madarosis (8%). Complications were more common in patients necessitating irradiation of the entire anterior segment than in patients which received sectorial irradiation. Eye retention was achieved in all cases. No statistically significant difference in the mean best corrected visual acuity (BCVA) and intraocular pressure (IOP) was found before and after treatment. Comparison of mean BCVA and IOP between different treatment groups (complete anterior segment vs sectorial irradiation) at the last follow-up visit were also not significantly different. No patient developed metastatic disease during follow-up. Conclusion PBRT is a safe and vision preserving therapeutic modality for iris melanoma. Complete irradiation of the anterior segment is associated with higher complication rates.
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Affiliation(s)
| | - Georgios Blatsios
- Department of Ophthalmology and Optometry, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Gertrud Haas
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Luisa Velez-Escola
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Christof Seifarth
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Teresa Rauchegger
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Bernhard Haider
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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Wierenga APA, Brouwer NJ, Gelmi MC, Verdijk RM, Stern MH, Bas Z, Malkani K, van Duinen SG, Ganguly A, Kroes WGM, Marinkovic M, Luyten GPM, Shields CL, Jager MJ. Chromosome 3 and 8q aberrations in Uveal Melanoma show greater impact on survival in patients with light iris versus dark iris color. Ophthalmology 2021; 129:421-430. [PMID: 34780841 DOI: 10.1016/j.ophtha.2021.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Individuals with gray, blue, or green iris have a higher chance of developing uveal melanoma (UM) than those with brown eyes. We wondered whether iris pigmentation might not only be related to predisposition to UM, but also to its behavior and therefore compared clinical, histopathologic, and genetic characteristics of UM between eyes with different iris colors. DESIGN We determined iris color in a large cohort of patients who had undergone an enucleation for UM. Clinical and histopathological tumor characteristics, chromosome status, and survival were compared between three groups, based on iris color. PARTICIPANTS 412 patients with choroidal/ciliary body UM, who had undergone primary enucleation at the Leiden University Medical Center (LUMC), Leiden, The Netherlands, between 1993 and 2019, divided into three groups, based on iris color (gray/blue, green/hazel, and brown). Validation cohort: 934 choroidal/ciliary body UM patients treated at Wills Eye Hospital (WEH), Philadelphia, United States. METHODS Comparison of clinical, histopathologic, and genetic characteristics of UM in patients with different iris colors. MAIN OUTCOME MEASURES Melanoma-related survival in UM patients, divided over three iris color groups, in relation to the tumor's chromosome 3 and 8q status. RESULTS Moderate and heavy tumor pigmentation was especially seen in eyes with brown iris (p < 0.001). Survival did not differ between patients with different iris colors (p = 0.28). However, in patients with a light iris, copy number changes in chromosome 3 and 8q had a greater influence on survival than in patients with a dark iris. Similarly, chromosome 3 and chromosome 8q status affected survival more among patients with lightly-pigmented tumors than in patients with heavily-pigmented tumors. The WEH cohort similarly showed a greater influence of chromosome aberrations in light-eyed individuals. CONCLUSIONS While iris color by itself did not relate to survival of UM patients, chromosome 3 and 8q aberrations had a much larger influence on survival in patients with light iris compared to those with brown iris. This suggests a synergistic effect of iris pigmentation and chromosome status in the regulation of oncogenic behavior of UM. Iris color should be taken into consideration when calculating the risk for developing metastases.
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Affiliation(s)
- Annemijn P A Wierenga
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels J Brouwer
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Chiara Gelmi
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology, Section Ophthalmic Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marc-Henri Stern
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Equipe labellisée par la Ligue, Nationale Contre le Cancer, Institut Curie, PSL Research University, Paris, France
| | - Zeynep Bas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kabir Malkani
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arupa Ganguly
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. USA
| | - Wilma G M Kroes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
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Al-Kharashi A, Alsakran WA, Alshamrani AA, AlZaid A, Maktabi AMY, Alzahrani YA. Iris Melanocytoma in a Child: Clinical and Histopathological Findings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931385. [PMID: 34153023 PMCID: PMC8235677 DOI: 10.12659/ajcr.931385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient: Male, 3-year-old Final Diagnosis: Iris melanocytoma Symptoms: Eye pain and redness • photophobia Medication: — Clinical Procedure: — Specialty: Ophthalmology
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Affiliation(s)
- Abdulkarim Al-Kharashi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,King Saud Medical City, Riyadh, Saudi Arabia
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Masaoutis C, Kokkali S, Theocharis S. Immunotherapy in uveal melanoma: novel strategies and opportunities for personalized treatment. Expert Opin Investig Drugs 2021; 30:555-569. [PMID: 33650931 DOI: 10.1080/13543784.2021.1898587] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Uveal melanoma (UM) is the most common intraocular cancer and represents a discrete subtype of melanoma. Metastatic disease, which occurs in half of patients, has a dismal prognosis. Immunotherapy with immune checkpoint inhibitors has produced promising results in cutaneous melanoma but has failed to show analogous efficacy in metastatic UM. This is attributable to UM's distinct genetics and its complex interaction with the immune system. Hence, more efficacious immunotherapeutic approaches are under investigation. AREAS COVERED We discuss those novel immunotherapeutic strategies in clinical and preclinical studies for advanced disease and which are thought to overcome the hurdles set by UM in terms of immune recognition. We also highlight the need to determine predictive markers in relation to these strategies to improve clinical outcomes. We used a simple narrative analysis to summarize the data. The search methodology is located in the Introduction. EXPERT OPINION Novel immunotherapeutic strategies focus on transforming immune excluded tumor microenvironment in metastatic UM to T cell inflamed. Preliminary results of approaches such as vaccines, adoptive cell transfer and other novel molecules are encouraging. Factors such as HLA compatibility and expression level of targeted antigens should be considered to optimize personalized management.
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Affiliation(s)
- Christos Masaoutis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,First Medical Oncology Clinic, Saint-Savvas Anticancer Hospital, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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