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Aye J, Gold A, Rodriguez B, Murray T. Gene Expression Profile Class Change in a Case of Aggressive, Recurrent Melanoma. JOURNAL OF VITREORETINAL DISEASES 2024; 8:93-96. [PMID: 38223774 PMCID: PMC10786084 DOI: 10.1177/24741264231215536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Purpose: To report a novel case of a recurrent melanoma that had a change in its genetic expression profile (GEP) class over a 2-year period. Methods: This retrospective case study evaluated a patient with a recurrent uveal melanoma that changed classes from 1A to 1B. Results: A large melanoma was first treated with brachytherapy, and during that time genetic testing revealed a class 1A tumor. Two years later the tumor was noted to be enlarging, and the patient elected for enucleation. Subsequent GEP showed a class 1B tumor. Conclusions: An aggressive and large recurrent uveal melanoma that had changed from a class 1A to a class 1B tumor on subsequent GEP testing has never been reported before to our knowledge. It may imply that a recurrent or aggressive tumor has more mutations over time that could lead to a higher risk for metastasis. The natural course of a tumor's GEP class should be explored further.
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Affiliation(s)
- Jennifer Aye
- Murray Ocular Oncology and Retina, Miami, FL, USA
| | - Aaron Gold
- Murray Ocular Oncology and Retina, Miami, FL, USA
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Valenzuela DA, Biscotti CV, Daniels AB. A Pigmented Iris Lesion. JAMA Ophthalmol 2022; 140:1239-1240. [PMID: 36301517 DOI: 10.1001/jamaophthalmol.2022.4484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A patient in their mid-60s presented with a left iris pigmented lesion that had been present for decades and remained stable in size. What would you do next?
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Affiliation(s)
- Daniel A Valenzuela
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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Williams BK, Siegel JJ, Alsina KM, Johnston L, Sisco A, LiPira K, Selig SM, Hovland PG. Uveal melanoma patient attitudes towards prognostic testing using gene expression profiling. Melanoma Manag 2022; 9:MMT62. [PMID: 36147875 PMCID: PMC9490505 DOI: 10.2217/mmt-2022-0003] [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: 07/25/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Aim: This study explored uveal melanoma patient experiences and regret following molecular prognostic testing using a 15-gene expression profile (GEP) test. Materials & methods: A retrospective, cross-sectional survey study was conducted through an online questionnaire capturing patient-reported experiences with prognostic biopsy/molecular testing. Results: Of 177 respondents, 159 (90%) wanted prognostic information at diagnosis. Most 15-GEP-tested patients who shared their results (99%) reported gaining value from testing, as did patients tested with other methods. Patients who received prognostic testing experienced lower decision regret than those who opted out. Decision regret did not differ based on GEP class. Conclusion: Most uveal melanoma patients desire prognostic testing and gain value from the GEP, independent of a high- or low-risk result. Uveal melanoma is a rare but aggressive eye cancer, resulting in distant metastasis in nearly 50% of patients. Molecular prognostic testing is often employed to determine who is at high or low risk of developing metastatic disease. A prognostic 15-gene expression profiling (GEP) test is commonly used throughout the USA and parts of Canada. The goal of this survey was to assess patient experiences with the 15-GEP and other prognostic methods. Of the 177 patients who participated in the survey, the majority reported that they wanted prognostic information at the time of diagnosis. Of patients who underwent 15-GEP testing, nearly all reported gaining value from their test result, regardless of their individual risk profile. This study supports prior findings using other prognostic methods that patients prefer information about their risk of metastasis and reinforces the importance of discussing prognostic testing options with newly diagnosed uveal melanoma patients.
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Affiliation(s)
- Basil K Williams
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA
| | | | | | | | - Amanda Sisco
- Colorado Retina Associates, Englewood, CO 80110, USA
| | | | - Sara M Selig
- Melanoma Research Foundation, Washington, DC 20005, USA
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Lei S, Zhang Y. Integrative analysis identifies key genes related to metastasis and a robust gene-based prognostic signature in uveal melanoma. BMC Med Genomics 2022; 15:61. [PMID: 35300699 PMCID: PMC8932077 DOI: 10.1186/s12920-022-01211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Uveal melanoma (UM) is an aggressive intraocular malignancy, leading to systemic metastasis in half of the patients. However, the mechanism of the high metastatic rate remains unclear. This study aimed to identify key genes related to metastasis and construct a gene-based signature for better prognosis prediction of UM patients. METHODS Weighted gene co-expression network analysis (WGCNA) was used to identify the co-expression of genes primarily associated with metastasis of UM. Univariate, Lasso-penalized and multivariate Cox regression analyses were performed to establish a prognostic signature for UM patients. RESULTS The tan and greenyellow modules were significantly associated with the metastasis of UM patients. Significant genes related to the overall survival (OS) in these two modules were then identified. Additionally, an OS-predicting signature was established. The UM patients were divided into a low- or high-risk group. The Kaplan-Meier curve indicated that high-risk patients had poorer OS than low-risk patients. The receiver operating curve (ROC) was used to validate the stability and accuracy of the final five-gene signature. Based on the signature and clinical traits of UM patients, a nomogram was established to serve in clinical practice. CONCLUSIONS We identified key genes involved in the metastasis of UM. A robust five-gene-based prognostic signature was constructed and validated. In addition, the gene signature-based nomogram was created that can optimize the prognosis prediction and identify possible factors causing the poor prognosis of high-risk UM patients.
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Affiliation(s)
- Shizhen Lei
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
| | - Yi Zhang
- Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University, 36 Sanhao Road, Shenyang, 110004, China.
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Lin V, Chung IY, Toumi E, McKay D, McKenzie J, McKelvie P, Zabih F, Hoffmeister A, Wright D, Ntzaferi A, Wu IJ, Hesson L, Fung A, Lim LA, Wong S, Field A, Earls P, Giblin M, Conway RM, Cherepanoff S. Biopsy for molecular risk stratification in uveal melanoma: Yields and molecular characteristics in 119 patients. Clin Exp Ophthalmol 2022; 50:50-61. [PMID: 34714583 DOI: 10.1111/ceo.14022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prognostic cytological and molecular features of uveal melanoma have been well researched and are essential in management. Samples can be obtained in vivo through fine needle aspirate biopsy, vitrector cutter, forceps or post-enucleation for off-site testing. This study aims to examine cytological and chromosome microarray yields of these samples. METHODS A retrospective cohort analysis of 119 uveal melanoma biopsies submitted to our laboratory. Samples included those taken in vivo (n = 57) and post-enucleation (n = 62). Patient and tumour features were collected including age, sex, primary tumour location, basal diameter and tumour height. Prognostic outcomes measured include cell morphology, chromosomal status and immunohistochemistry. RESULTS Post-enucleation biopsies accounted for just over half of our samples (52%). Post-enucleation samples had a more successful genetic yield than in vivo biopsies (77% vs. 50%, p = 0.04) though there was no difference for cytological yields. There was no difference in cytological or microarray yields between instruments. The vitrector biopsy group had the smallest tumour thickness (5 mm vs. 10 mm [fine-needle aspirate biopsy], p = 0.003). There was a strong correlation between monosomy 3, BAP1 aberrancy and epithelioid cell type in post-enucleation samples (Tb = 0.742, p = 0.005). However, epithelioid morphology was not associated with either monosomy 3 (p = 0.07) or BAP1 aberrancy (p = 0.24) for in vivo biopsies. CONCLUSIONS All three biopsy instruments provide similar cytological yields as post-enucleation sampling, although post-enucleation samples had a more successful chromosome microarray yield. Epithelioid cytomorphology alone is insufficient for prognostication in in vivo biopsies, immunohistochemistry would be a useful surrogate test.
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Affiliation(s)
- Vivian Lin
- School of Medical Sciences, Faculty of Medicine, UNSW, Sydney, Australia
| | - In Young Chung
- Royal Victorian Eye & Ear Hospital, Melbourne, Australia
| | - Elsa Toumi
- Department of Anatomical Pathology and Molecular Oncology, SydPath, St Vincent's Hospital Sydney, Sydney, Australia
| | - Daniel McKay
- Royal Victorian Eye & Ear Hospital, Melbourne, Australia
| | - John McKenzie
- Royal Victorian Eye & Ear Hospital, Melbourne, Australia
| | - Penny McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Farida Zabih
- Department of Cancer Genetics, SydPath, St Vincent's Hospital, Sydney, Australia
| | | | - Dale Wright
- Department of Cytogenetics, Children's Hospital Westmead, Westmead, Australia
- Discipline of Paediatrics & Child Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Aphrodite Ntzaferi
- Department of Cancer Genetics, SydPath, St Vincent's Hospital, Sydney, Australia
| | - Iris Junhong Wu
- Department of Cancer Genetics, SydPath, St Vincent's Hospital, Sydney, Australia
| | - Luke Hesson
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia
- Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- Department of Molecular Genetics, Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - Adrian Fung
- Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Li-Anne Lim
- Chatswood Private Hospital, Chatswood, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Stephen Wong
- Department of Anatomical Pathology and Molecular Oncology, SydPath, St Vincent's Hospital Sydney, Sydney, Australia
| | - Andrew Field
- Department of Anatomical Pathology and Molecular Oncology, SydPath, St Vincent's Hospital Sydney, Sydney, Australia
| | - Peter Earls
- Department of Anatomical Pathology and Molecular Oncology, SydPath, St Vincent's Hospital Sydney, Sydney, Australia
| | - Michael Giblin
- Chatswood Private Hospital, Chatswood, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Robert Max Conway
- Westmead and Central Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Svetlana Cherepanoff
- Department of Anatomical Pathology and Molecular Oncology, SydPath, St Vincent's Hospital Sydney, Sydney, Australia
- Faculty of Medicine, St Vincent's Clinical School, Sydney, Australia
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Mallone F, Sacchetti M, Lambiase A, Moramarco A. Molecular Insights and Emerging Strategies for Treatment of Metastatic Uveal Melanoma. Cancers (Basel) 2020; 12:E2761. [PMID: 32992823 PMCID: PMC7600598 DOI: 10.3390/cancers12102761] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
Uveal melanoma (UM) is the most common intraocular cancer. In recent decades, major advances have been achieved in the diagnosis and prognosis of UM allowing for tailored treatments. However, nearly 50% of patients still develop metastatic disease with survival rates of less than 1 year. There is currently no standard of adjuvant and metastatic treatment in UM, and available therapies are ineffective resulting from cutaneous melanoma protocols. Advances and novel treatment options including liver-directed therapies, immunotherapy, and targeted-therapy have been investigated in UM-dedicated clinical trials on single compounds or combinational therapies, with promising results. Therapies aimed at prolonging or targeting metastatic tumor dormancy provided encouraging results in other cancers, and need to be explored in UM. In this review, the latest progress in the diagnosis, prognosis, and treatment of UM in adjuvant and metastatic settings are discussed. In addition, novel insights into tumor genetics, biology and immunology, and the mechanisms underlying metastatic dormancy are discussed. As evident from the numerous studies discussed in this review, the increasing knowledge of this disease and the promising results from testing of novel individualized therapies could offer future perspectives for translating in clinical use.
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Affiliation(s)
| | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00161 Rome, Italy; (F.M.); (M.S.); (A.M.)
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