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Liu XL, Run-Hua Z, Pan JX, Li ZJ, Yu L, Li YL. Emerging therapeutic strategies for metastatic uveal melanoma: Targeting driver mutations. Pigment Cell Melanoma Res 2024; 37:411-425. [PMID: 38411373 DOI: 10.1111/pcmr.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024]
Abstract
Uveal melanoma (UM) is the most common primary malignant intraocular tumor in adults. Although primary UM can be effectively controlled, a significant proportion of cases (40% or more) eventually develop distant metastases, commonly in the liver. Metastatic UM remains a lethal disease with limited treatment options. The initiation of UM is typically attributed to activating mutations in GNAQ or GNA11. The elucidation of the downstream pathways such as PKC/MAPK, PI3K/AKT/mTOR, and Hippo-YAP have provided potential therapeutic targets. Concurrent mutations in BRCA1 associated protein 1 (BAP1) or splicing factor 3b subunit 1 (SF3B1) are considered crucial for the acquisition of malignant potential. Furthermore, in preclinical studies, actionable targets associated with BAP1 loss or oncogenic mutant SF3B1 have been identified, offering promising avenues for UM treatment. This review aims to summarize the emerging targeted and epigenetic therapeutic strategies for metastatic UM carrying specific driver mutations and the potential of combining these approaches with immunotherapy, with particular focus on those in upcoming or ongoing clinical trials.
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Affiliation(s)
- Xiao-Lian Liu
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Zhou Run-Hua
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Jing-Xuan Pan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhi-Jie Li
- Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Le Yu
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Yi-Lei Li
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
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2
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Villy MC, Le Ven A, Le Mentec M, Masliah-Planchon J, Houy A, Bièche I, Vacher S, Vincent-Salomon A, Dubois d'Enghien C, Schwartz M, Piperno-Neumann S, Matet A, Malaise D, Bubien V, Lortholary A, Ait Omar A, Cavaillé M, Stoppa-Lyonnet D, Cassoux N, Stern MH, Rodrigues M, Golmard L, Colas C. Familial uveal melanoma and other tumors in 25 families with monoallelic germline MBD4 variants. J Natl Cancer Inst 2024; 116:580-587. [PMID: 38060262 DOI: 10.1093/jnci/djad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Monoallelic germline MBD4 pathogenic variants were recently reported to cause a predisposition to uveal melanoma, associated with a specific tumor mutational signature and good response to immunotherapy. Monoallelic tumor pathogenic variants have also been described in brain tumors, breast cancers, and myxofibrosarcomas, whereas biallelic germline MBD4 pathogenic variants have been involved in a recessive hereditary adenomatous polyposis and a specific type of acute myeloid leukemia. METHODS We analyzed MBD4 for all patients with a diagnosis of uveal melanoma at Institut Curie since July 2021 and in the 3240 consecutive female probands explored at the Institut Curie for suspicion of predisposition to breast cancer between July 2021 and February 2023. RESULTS We describe 25 families whose probands carry a monoallelic germline pathogenic variant in MBD4. Eighteen of these families presented with uveal melanoma (including a case patient with multiple uveal melanoma), and 7 families presented with breast cancer. Family histories showed the first familial case of uveal melanoma in monoallelic MBD4 pathogenic variant carriers and other various types of cancers in relatives, especially breast, renal, and colorectal tumors. CONCLUSIONS Monoallelic MBD4 pathogenic variant may explain some cases of familial and multiple uveal melanoma as well as various cancer types, expanding the tumor spectrum of this predisposition. Further genetic testing in relatives combined with molecular tumor analyses will help define the tumor spectrum and estimate each tumor's risk.
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Affiliation(s)
- Marie-Charlotte Villy
- Department of Genetics, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Anaïs Le Ven
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
| | - Marine Le Mentec
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Julien Masliah-Planchon
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Alexandre Houy
- Paris Sciences & Lettres Research University, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
| | - Ivan Bièche
- Department of Genetics, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
| | - Sophie Vacher
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Anne Vincent-Salomon
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Catherine Dubois d'Enghien
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Mathias Schwartz
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Sophie Piperno-Neumann
- Paris Sciences & Lettres Research University, Paris, France
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Alexandre Matet
- Université Paris Cité, Paris, France
- Department of Ocular Oncology, Institut Curie, Paris, France
| | - Denis Malaise
- Paris Sciences & Lettres Research University, Paris, France
- Department of Ocular Oncology, Institut Curie, Paris, France
| | | | - Alain Lortholary
- Department of Medical Oncology, GINECO-Hôpital Privé du Confluent, Nantes, France
| | - Amal Ait Omar
- Department of Gastroenterology, AP-HP, Hôpital Avicenne, Bobigny, France
| | - Mathias Cavaillé
- Department of Oncogenetics, Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, AURAGEN, Clermont-Ferrand, France
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, Paris, France
- Université Paris Cité, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
| | - Nathalie Cassoux
- Université Paris Cité, Paris, France
- Department of Ocular Oncology, Institut Curie, Paris, France
| | - Marc-Henri Stern
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
| | - Manuel Rodrigues
- Paris Sciences & Lettres Research University, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Lisa Golmard
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
| | - Chrystelle Colas
- Department of Genetics, Institut Curie, Paris, France
- Paris Sciences & Lettres Research University, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Paris, France
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Gelmi MC, Jager MJ. Uveal melanoma: Current evidence on prognosis, treatment and potential developments. Asia Pac J Ophthalmol (Phila) 2024; 13:100060. [PMID: 38641203 DOI: 10.1016/j.apjo.2024.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024] Open
Abstract
Uveal Melanoma (UM) is a rare disease, yet it is the most common primary intraocular malignancy in adult patients. Despite continuous advancements and research, the risk of metastasis remains high. It is possible to stratify patients according to their risk of metastases using a variety of known risk factors. Even though there is no gold standard for the prognostication of patients with uveal melanoma, it is becoming increasingly clear that combining histo-pathological, patient-related and molecular prognostic markers allows a more accurate prediction of the metastatic risk than by using one parameter. Primary UM in the eye are treated very effectively with eye-sparing radiation-based techniques or enucleation. However, it is not yet possible to prevent or treat metastases with the current therapeutic options. Nonetheless, the efforts to find new therapeutic targets continue and progress is being made, especially in the field of targeted therapy, as exemplified by the anti-gp100 bispecific molecule Tebentafusp. This review delves into the history of uveal melanoma, its incidence, presentation and diagnosis, the known prognostic factors and the treatment options, both for the primary tumour and for metastases. We show that different populations may have different risks for developing UM, and that each country should evaluate their own patients.
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Affiliation(s)
- Maria Chiara Gelmi
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.
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4
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Valle L, Monahan KJ. Genetic predisposition to gastrointestinal polyposis: syndromes, tumour features, genetic testing, and clinical management. Lancet Gastroenterol Hepatol 2024; 9:68-82. [PMID: 37931640 DOI: 10.1016/s2468-1253(23)00240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 11/08/2023]
Abstract
Gastrointestinal tract polyposis is characterised by the presence of multiple polyps, particularly in the colorectum, and encompasses both cancer predisposition genetic syndromes and non-syndromic clinical manifestations. The sources of the heterogeneity observed in polyposis syndromes relate to genetic cause, mode of inheritance, polyp burden and histological type, and spectrum and frequency of extracolonic manifestations. These features determine the clinical management of carriers, including strategies for cancer prevention and early detection, and oncological treatments. Despite substantial progress in identifying the genetic causes of polyposis, a large proportion of cases remain genetically unexplained. Although some of these cases might be due to lifestyle, environmental factors, or cancer treatments, it is likely that additional polyposis predisposition genes will be identified. This Review provides an overview of the known syndromes and genes, genetic testing, and clinical management of patients with polyposis, and recent advances and challenges in the field of gastrointestinal polyposis.
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Affiliation(s)
- Laura Valle
- Hereditary Cancer Programme, Catalan Institute of Oncology, Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
| | - Kevin J Monahan
- The St Mark's Centre for Familial Intestinal Cancer Lynch Syndrome & Family Cancer Clinic & Polyposis Registry, St Mark's Hospital, London, UK; Imperial College, London, UK.
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5
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Gelmi MC, Gezgin G, van der Velden PA, Luyten GPM, Luk SJ, Heemskerk MHM, Jager MJ. PRAME Expression: A Target for Cancer Immunotherapy and a Prognostic Factor in Uveal Melanoma. Invest Ophthalmol Vis Sci 2023; 64:36. [PMID: 38149971 PMCID: PMC10755595 DOI: 10.1167/iovs.64.15.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose Uveal melanoma (UM) is a rare disease with a high mortality, and new therapeutic options are being investigated. Preferentially Expressed Antigen in Melanoma (PRAME) is a cancer testis antigen, expressed in the testis, but also in cancers, including uveal melanoma. PRAME is considered a target for immune therapy in several cancers, and PRAME-specific T cell clones have been shown to kill UM cells. Methods We studied the literature on PRAME expression in hematological and solid malignancies, including UM, and its role as a target for immunotherapy. The distribution of tumor features was compared between PRAME-high and PRAME-low UM in a 64-patient cohort from the Leiden University Medical Center (LUMC) and in the Cancer Genome Atlas (TCGA) cohort of 80 cases and differential gene expression analysis was performed in the LUMC cohort. Results PRAME is expressed in many malignancies, it is frequently associated with a negative prognosis, and can be the target of T cell receptor (TCR)-transduced T cells, a promising treatment option with high avidity and safety. In UM, PRAME is expressed in 26% to 45% of cases and is correlated with a worse prognosis. In the LUMC and the TCGA cohorts, high PRAME expression was associated with larger diameter, higher Tumor-Node-Metastasis (TNM) stage, more frequent gain of chromosome 8q, and an inflammatory phenotype. Conclusions We confirm that PRAME is associated with poor prognosis in UM and has a strong connection with extra copies of 8q. We show that PRAME-specific immunotherapy in an adjuvant setting is promising in treatment of malignancies, including UM.
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Affiliation(s)
- Maria Chiara Gelmi
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gulçin Gezgin
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Sietse J. Luk
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Martine J. Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
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Terradas M, Gonzalez-Abuin N, García-Mulero S, Viana-Errasti J, Aiza G, Piulats JM, Brunet J, Capellá G, Valle L. MBD4-associated neoplasia syndrome: screening of cases with suggestive phenotypes. Eur J Hum Genet 2023; 31:1185-1189. [PMID: 37402954 PMCID: PMC10545785 DOI: 10.1038/s41431-023-01418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/06/2023] Open
Abstract
Germline mutations in MBD4, which, like MUTYH and NTHL1, encodes a glycosylase of the DNA based excision repair system, cause an autosomal recessive syndrome characterised by increased risk of acute myeloid leukaemia, gastrointestinal polyposis, colorectal cancer (CRC) and, to a lesser extent, uveal melanoma and schwannomas. To better define the phenotypic spectrum and tumour molecular features associated with biallelic MBD4-associated cancer predisposition, and study if heterozygous variants are associated with gastrointestinal tumour predisposition, we evaluated germline MBD4 status in 728 patients with CRC, polyposis, and other suggestive phenotypes (TCGA and in-house cohorts). Eight CRC patients carried rare homozygous or heterozygous germline variants in MBD4. The information gathered on mode of inheritance, variant nature, functional effect of the variant, and tumour mutational characteristics suggested that none of the patients included in the study had an MBD4-associated hereditary syndrome and that the heterozygous variants identified were not associated with the disease.
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Affiliation(s)
- Mariona Terradas
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Noemi Gonzalez-Abuin
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra García-Mulero
- Cancer Immunotherapy (CIT) Group-iPROCURE, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Programme (ODAP), Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Julen Viana-Errasti
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Aiza
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep M Piulats
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Cancer Immunotherapy (CIT) Group-iPROCURE, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Medical Oncology Department, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
- Catalan Institute of Oncology, IDIBGi, Girona, Spain
| | - Gabriel Capellá
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Laura Valle
- Hereditary Cancer Programme, Catalan Institute of Oncology; Oncobell Programme, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
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Gerard C, Shum B, Nathan P, Turajlic S. Immuno-oncology approaches in uveal melanoma: tebentafusp and beyond. IMMUNO-ONCOLOGY TECHNOLOGY 2023; 19:100386. [PMID: 37483658 PMCID: PMC10362360 DOI: 10.1016/j.iotech.2023.100386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Uveal melanoma (UM) is the most common ocular malignancy in adults, associated with the poorest prognosis, with metastatic disease occurring in up to 50% of patients. In contrast to metastatic cutaneous melanoma, the use of immune checkpoint inhibitors is associated with poor outcomes in metastatic uveal melanoma (mUM). Tebentafusp, a bispecific molecule, has recently become the first treatment in decades to improve overall survival for mUM. This review summarises the existing and emerging immuno-oncology approaches for the treatment of mUM, and biomarkers of response and resistance to the same. Finally, we propose future research directions that could maximise treatment benefit to a wider pool of patients with UM.
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Affiliation(s)
- C. Gerard
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Precision Oncology Center, Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - B. Shum
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Unit, The Royal Marsden NHS Foundation Trust, London
| | - P. Nathan
- Mount Vernon Cancer Centre, East and North Herts NHS Trust, Northwood, UK
| | - S. Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK
- Skin and Renal Unit, The Royal Marsden NHS Foundation Trust, London
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8
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Mariani P, Torossian N, van Laere S, Vermeulen P, de Koning L, Roman-Roman S, Lantz O, Rodrigues M, Stern MH, Gardrat S, Lesage L, Champenois G, Nicolas A, Matet A, Cassoux N, Servois V, Romano E, Piperno-Neumann S, Lugassy C, Barnhill R. Immunohistochemical characterisation of the immune landscape in primary uveal melanoma and liver metastases. Br J Cancer 2023; 129:772-781. [PMID: 37443346 PMCID: PMC10449826 DOI: 10.1038/s41416-023-02331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/16/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The immune landscape of uveal melanoma liver metastases (UMLM) has not been sufficiently studied. METHODS Immune cell infiltrates (ICIs), PD-1 and PD-L1 were characterised in 62 UMLM and 28 primary uveal melanomas (PUM). ICI, PD-1 and PD-L1 were scored as: (1) % tumoral area occupied by tumour-infiltrating lymphocytes or macrophages (TILs, TIMs) and (2) % perTumoral (perT) area. ICIs and other variables including histopathologic growth patterns (HGPs), replacement and desmoplastic, of UMLM were analysed for their prognostic value. RESULTS ICIs recognised by haematoxylin-eosin-saffron (HES) and IHC (e.g., T cells (CD3), B cells (CD20). Macrophages (CD68), (CD163), were primarily localised to the perT region in PUM and UMLM and were more conspicuous in UMLM. HES, CD3, CD4, FoxP3, CD8, CD20, PD-1 TILs were scant (<5%). TIMs were more frequent, particularly in UMLM than in PUM. Both CD68+ TIMs and HGPs remained significant on multivariate analysis, influencing overall (OS) and metastasis-specific overall survival (MSOS). CD68 + , CD163+ and CD20+ perT infiltrates in UMLM predicted increased OS and MSOS on univariate analysis. CONCLUSIONS TILs and PD-L1 have no predictive value in PUM or UMLM. CD68+ and CD163+TIMs, CD20+ perT lymphocytes, and HGPs are important prognostic factors in UMLMs.
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Affiliation(s)
| | | | - Steven van Laere
- Faculty of Medicine and Health Sciences, University of Antwerp-MIPRO Center for Oncological Research (CORE) - TCRU, GZA Sint-Augustinus, Antwerp, Belgium
| | - Peter Vermeulen
- Faculty of Medicine and Health Sciences, University of Antwerp-MIPRO Center for Oncological Research (CORE) - TCRU, GZA Sint-Augustinus, Antwerp, Belgium
| | - Leanne de Koning
- Department of Translational Research, Institut Curie, Paris, France
| | | | - Olivier Lantz
- Laboratoire d'immunologie clinique, Institut Curie, Paris, France
- Centre d'investigation Clinique en Biothérapie, Institut Curie (CIC-BT1428), Paris, France
- INSERM U932, PSL University, Institut Curie, Paris, France
| | - Manuel Rodrigues
- Department of Medical Oncology, Institut Curie, Paris, France
- Inserm U830, DNA Repair and Uveal Melanoma (D.R.U.M.), Equipe Labellisée Par la Ligue Nationale Contre le Cancer, Institut Curie, Paris, France
| | - 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, Paris, France
| | | | | | | | - André Nicolas
- Department of Pathology, Institut Curie, Paris, France
| | - Alexandre Matet
- Department of Ophthalmology, Institut Curie, Paris, France
- Université de Paris Cité UFR de Médecine, Paris, France
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, Paris, France
- Université de Paris Cité UFR de Médecine, Paris, France
| | | | - Emanuela Romano
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Claire Lugassy
- Department of Translational Research, Institut Curie, Paris, France
| | - Raymond Barnhill
- Department of Translational Research, Institut Curie, Paris, France.
- Université de Paris Cité UFR de Médecine, Paris, France.
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9
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Pham JP, On L, Ardolino L, Hurwitz J, Salaun H, Sim HW, Joshua AM. Efficacy of immune checkpoint inhibition in metastatic uveal melanoma: a systematic review and meta-analysis. Melanoma Res 2023; 33:316-325. [PMID: 37199712 DOI: 10.1097/cmr.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Metastatic uveal melanoma (mUM) has historically been associated with short survival and limited effective treatments. Immune checkpoint inhibitors (ICIs) have been trialed in mUM; however, robust conclusions regarding their efficacy are difficult to draw given small study sizes and heterogeneous patient populations. Five databases were searched using a combination of 'ICI' and 'mUM' headings, and data on patient demographics, objective response rate (ORR), overall survival (OS) and progression-free survival (PFS) were extracted. Pooled ORR was calculated using a random effects model and the inverse variance method. Available Kaplan-Meier OS and PFS curves were used to construct summary OS and PFS plots, from which median values were derived. Pooled ORR was 9.2% overall (95% CI 7.2-11.8) [4.1% for anti-CTLA4 (95% CI 2.1-7.7), 7.1% for anti-PD(L)1 (95% CI 4.5-10.9) and 13.5% for anti-CTLA4 plus anti-PD1 (95% CI 10.0-18.0)]. Median OS was 11.5 months overall (95% CI 9.5-13.8) [8.0 months for anti-CTLA4 (95% CI 5.5-9.9), 11.7 months for anti-PD(L)1 (95% CI 9.0-14.0) and 16.0 months for ipilimumab plus anti-PD1 (95% CI 11.5-17.7) ( P < 0.001)]. Median PFS was 3.0 months overall (95% CI 2.9-3.1). ICIs have limited efficacy in mUM and a recommendation for their use must consider the balance of benefit and risk for individual patients if no other options are available. Further biomarker profiling studies may be helpful in assessing which patients will benefit from ICIs, in particular the addition of ipilimumab to anti-PD1 therapy.
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Affiliation(s)
- James P Pham
- Department of Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
| | - Lawrence On
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, NSW, Australia
| | - Luke Ardolino
- Department of Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
| | - Joshua Hurwitz
- Department of Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
| | - Helene Salaun
- Department of Medical Oncology, PSL Research University, Institut Curie, Paris, France
| | - Hao-Wen Sim
- Department of Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
- Department of Medical Oncology, NHMRC Clinical Trials Centre, University of Sydney, Camperdown
| | - Anthony M Joshua
- Department of Medical Oncology, The Kinghorn Cancer Centre, St. Vincent's Hospital Sydney
- School of Clinical Medicine, UNSW Medicine and Health, St Vincent's Hospital, Darlinghurst
- Melanoma Institute Australia, University of Sydney, North Sydney, NSW, Australia
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Champiat S, Salaün H, Lucibello F, Scoazec JY, Besse B, Lalanne AI, Rouleau E, Metzger N, Saint-Ghislain M, Ryckewaert T, Gardrat S, Barnhill R, Cassoux N, Stern MH, Lantz O, de Koning L, Marabelle A, Rodrigues M. Exceptional Response to Dual Colony-Stimulating Factor 1 Receptor/PD-L1 Targeting After Primary Resistance to PD-1 Inhibition in a Patient With a Metastatic Uveal Melanoma. JCO Precis Oncol 2023; 7:e2200363. [PMID: 37224427 DOI: 10.1200/po.22.00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/03/2023] [Accepted: 04/05/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Stéphane Champiat
- Drug Development Department, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
- Department of Translational Research, University Paris-Saclay, Inserm U1015, Villejuif, France
- University Paris-Saclay, Inserm, Clinical Investigation Center (CIC-BT1428) Biotheris, Villejuif, France
| | - Hélène Salaün
- Medical Oncology Department, PSL Research University, Institut Curie, Paris, France
| | - Francesca Lucibello
- Center for Cancer Immunotherapy, INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Jean-Yves Scoazec
- Department of Biopathology, University Paris-Saclay, Gustave Roussy Cancer Center, Villejuif, France
| | - Benjamin Besse
- Paris Saclay University, Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Ana Ines Lalanne
- Clinical Immunology Laboratory, Institut Curie, Paris, France
- Clinical Investigation Center (CIC-BT1428), Institut Curie, Paris, France
| | - Etienne Rouleau
- Department of Biopathology, University Paris-Saclay, Gustave Roussy Cancer Center, Villejuif, France
| | - Nolwenn Metzger
- Department of Somatic Genetics, Institut Curie, PSL Research University, Paris, France
| | | | | | - Sophie Gardrat
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
- Unit 830 (Cancer, Heterogeneity, Instability and Plasticity) INSERM, Institut Curie, PSL Research University, Paris, France
| | - Raymond Barnhill
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, PSL Research University, Paris, France
| | - Marc-Henri Stern
- Unit 830 (Cancer, Heterogeneity, Instability and Plasticity) INSERM, Institut Curie, PSL Research University, Paris, France
| | - Olivier Lantz
- Center for Cancer Immunotherapy, INSERM U932, Institut Curie, PSL Research University, Paris, France
- Clinical Immunology Laboratory, Institut Curie, Paris, France
- Clinical Investigation Center (CIC-BT1428), Institut Curie, Paris, France
| | - Leanne de Koning
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Aurélien Marabelle
- Drug Development Department, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - Manuel Rodrigues
- Medical Oncology Department, PSL Research University, Institut Curie, Paris, France
- Unit 830 (Cancer, Heterogeneity, Instability and Plasticity) INSERM, Institut Curie, PSL Research University, Paris, France
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11
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de Bruyn DP, Bongaerts M, Bonte R, Vaarwater J, Meester-Smoor MA, Verdijk RM, Paridaens D, Naus NC, de Klein A, Ruijter GJG, Kiliç E, Brosens E. Uveal Melanoma Patients Have a Distinct Metabolic Phenotype in Peripheral Blood. Int J Mol Sci 2023; 24:ijms24065077. [PMID: 36982149 PMCID: PMC10049075 DOI: 10.3390/ijms24065077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Uveal melanomas (UM) are detected earlier. Consequently, tumors are smaller, allowing for novel eye-preserving treatments. This reduces tumor tissue available for genomic profiling. Additionally, these small tumors can be hard to differentiate from nevi, creating the need for minimally invasive detection and prognostication. Metabolites show promise as minimally invasive detection by resembling the biological phenotype. In this pilot study, we determined metabolite patterns in the peripheral blood of UM patients (n = 113) and controls (n = 46) using untargeted metabolomics. Using a random forest classifier (RFC) and leave-one-out cross-validation, we confirmed discriminatory metabolite patterns in UM patients compared to controls with an area under the curve of the receiver operating characteristic of 0.99 in both positive and negative ion modes. The RFC and leave-one-out cross-validation did not reveal discriminatory metabolite patterns in high-risk versus low-risk of metastasizing in UM patients. Ten-time repeated analyses of the RFC and LOOCV using 50% randomly distributed samples showed similar results for UM patients versus controls and prognostic groups. Pathway analysis using annotated metabolites indicated dysregulation of several processes associated with malignancies. Consequently, minimally invasive metabolomics could potentially allow for screening as it distinguishes metabolite patterns that are putatively associated with oncogenic processes in the peripheral blood plasma of UM patients from controls at the time of diagnosis.
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Affiliation(s)
- Daniël P. de Bruyn
- Department of Ophthalmology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Michiel Bongaerts
- Department of Clinical Genetics, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Ramon Bonte
- Department of Clinical Genetics, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Jolanda Vaarwater
- Department of Ophthalmology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | | | - Robert M. Verdijk
- The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands
- Department of Pathology, Section Ophthalmic Pathology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Dion Paridaens
- Department of Ophthalmology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- The Rotterdam Eye Hospital, 3011 BH Rotterdam, The Netherlands
| | - Nicole C. Naus
- Department of Ophthalmology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | | | - Emine Kiliç
- Department of Ophthalmology, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3000 CA Rotterdam, The Netherlands
| | - Erwin Brosens
- Department of Clinical Genetics, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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12
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Carvajal RD, Sacco JJ, Jager MJ, Eschelman DJ, Olofsson Bagge R, Harbour JW, Chieng ND, Patel SP, Joshua AM, Piperno-Neumann S. Advances in the clinical management of uveal melanoma. Nat Rev Clin Oncol 2023; 20:99-115. [PMID: 36600005 DOI: 10.1038/s41571-022-00714-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/05/2023]
Abstract
Melanomas arising in the uveal tract of the eye are a rare form of the disease with a biology and clinical phenotype distinct from their more common cutaneous counterparts. Treatment of primary uveal melanoma with radiotherapy, enucleation or other modalities achieves local control in more than 90% of patients, although 40% or more ultimately develop distant metastases, most commonly in the liver. Until January 2022, no systemic therapy had received regulatory approval for patients with metastatic uveal melanoma, and these patients have historically had a dismal prognosis owing to the limited efficacy of the available treatments. A series of seminal studies over the past two decades have identified highly prevalent early, tumour-initiating oncogenic genomic aberrations, later recurring prognostic alterations and immunological features that characterize uveal melanoma. These advances have driven the development of a number of novel emerging treatments, including tebentafusp, the first systemic therapy to achieve regulatory approval for this disease. In this Review, our multidisciplinary and international group of authors summarize the biology of uveal melanoma, management of primary disease and surveillance strategies to detect recurrent disease, and then focus on the current standard and emerging regional and systemic treatment approaches for metastatic uveal melanoma.
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Affiliation(s)
- Richard D Carvajal
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Joseph J Sacco
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Martine J Jager
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - David J Eschelman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - J William Harbour
- Department of Ophthalmology and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas D Chieng
- Medical Imaging Services, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sapna P Patel
- Department of Melanoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre, St Vincent's Hospital Sydney and Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW Medicine & Health, St Vincent's Healthcare Clinical Campus, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
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13
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Barbagallo C, Stella M, Broggi G, Russo A, Caltabiano R, Ragusa M. Genetics and RNA Regulation of Uveal Melanoma. Cancers (Basel) 2023; 15:775. [PMID: 36765733 PMCID: PMC9913768 DOI: 10.3390/cancers15030775] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
Uveal melanoma (UM) is the most common intraocular malignant tumor and the most frequent melanoma not affecting the skin. While the rate of UM occurrence is relatively low, about 50% of patients develop metastasis, primarily to the liver, with lethal outcome despite medical treatment. Notwithstanding that UM etiopathogenesis is still under investigation, a set of known mutations and chromosomal aberrations are associated with its pathogenesis and have a relevant prognostic value. The most frequently mutated genes are BAP1, EIF1AX, GNA11, GNAQ, and SF3B1, with mutually exclusive mutations occurring in GNAQ and GNA11, and almost mutually exclusive ones in BAP1 and SF3B1, and BAP1 and EIF1AX. Among chromosomal aberrations, monosomy of chromosome 3 is the most frequent, followed by gain of chromosome 8q, and full or partial loss of chromosomes 1 and 6. In addition, epigenetic mechanisms regulated by non-coding RNAs (ncRNA), namely microRNAs and long non-coding RNAs, have also been investigated. Several papers investigating the role of ncRNAs in UM have reported that their dysregulated expression affects cancer-related processes in both in vitro and in vivo models. This review will summarize current findings about genetic mutations, chromosomal aberrations, and ncRNA dysregulation establishing UM biology.
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Affiliation(s)
- Cristina Barbagallo
- Department of Biomedical and Biotechnological Sciences—Section of Biology and Genetics, University of Catania, 95123 Catania, Italy
| | - Michele Stella
- Department of Biomedical and Biotechnological Sciences—Section of Biology and Genetics, University of Catania, 95123 Catania, Italy
| | - Giuseppe Broggi
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia—Section of Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy
| | - Rosario Caltabiano
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia—Section of Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Marco Ragusa
- Department of Biomedical and Biotechnological Sciences—Section of Biology and Genetics, University of Catania, 95123 Catania, Italy
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14
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Gaillard A, Matet A, Rodrigues M. [New drug approval: Tebentafusp for treatment of metastatic uveal melanoma HLA A*02:01-positive patients]. Bull Cancer 2023; 110:9-10. [PMID: 36357199 DOI: 10.1016/j.bulcan.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Antoine Gaillard
- CHRU Morvan-UBO (Université de Bretagne Occidentale), Service d'oncologie-radiothérapie, 2, avenue Foch, 29200 Brest, France.
| | - Alexandre Matet
- Inserm UMR1138 & Université Paris Cité, Institut Curie, Service d'ophtalmologie, 26 rue d'Ulm, 75248 Paris cedex 05, France.
| | - Manuel Rodrigues
- Institut Curie, Service d'oncologie médicale & INSERM U830, 26, rue d'Ulm, 75005 Paris, France.
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15
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Prognostic Hematologic Biomarkers Following Immune Checkpoint Inhibition in Metastatic Uveal Melanoma. Cancers (Basel) 2022; 14:cancers14235789. [PMID: 36497270 PMCID: PMC9738244 DOI: 10.3390/cancers14235789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background: There is no standardized treatment for metastatic uveal melanoma (MUM) but immune checkpoint inhibitors (ICI) are increasingly used. While ICI has transformed the survival of metastatic cutaneous melanoma, MUM patients do not equally benefit. Factors known to affect ICI response include the hematologic markers, lactate dehydrogenase (LDH) and neutrophil:lymphocyte ratio (NLR). We evaluated the prognostic value of LDH and NLR at the start of ICI and on treatment in MUM. Methods: MUM patients were treated between August 2006 and May 2022 with combination ipilimumab/nivolumab or ipilimumab/nivolumab/pembrolizumab single-agent therapy. Univariable (UVA) and multivariable (MVA) analyses were used to assess the prognostic value of predefined baseline factors on progression-free (PFS) and overall survival (OS). Results: In forty-six patients with MUM treated with ICI, elevated baseline and on-treatment LDH was prognostic for OS (start of ICI, HR (95% CI): 3.6 (1.9−7.0), p < 0.01; on-treatment, HR (95% CI): 3.7 (1.6−8.8), p < 0.01) and PFS (start of ICI, (HR (95% CI): 2.8 (1.5−5.4), p < 0.0001); on-treatment LDH (HR (95% CI): 2.2 (1.1−4.3), p < 0.01). On-treatment NLR was prognostic for PFS (HR (95% CI): 1.9 (1.0−3.9), p < 0.01). On-treatment LDH remained an important contributor to survival on MVA (OS: HR (95% CI): 1.001 (1.00−1.002), p < 0.05); PFS: HR (95% CI): 1.001 (1.00−1.002), p < 0.01). Conclusions: This study demonstrates that LDH and NLR could be useful in the prognostication of MUM patients treated with ICI. Additional studies are needed to confirm the importance of these and other prognostic biomarkers.
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