1
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Harbour JW, Correa ZM, Schefler AC, Mruthyunjaya P, Materin MA, Aaberg TA, Skalet AH, Reichstein DA, Weis E, Kim IK, Fuller TS, Demirci H, Piggott KD, Williams BK, Shildkrot E, Capone A, Oliver SC, Walter SD, Mason J, Char DH, Altaweel M, Wells JR, Duker JS, Hovland PG, Gombos DS, Tsai T, Javid C, Marr BP, Gao A, Decatur CL, Dollar JJ, Kurtenbach S, Zhang S. 15-Gene Expression Profile and PRAME as Integrated Prognostic Test for Uveal Melanoma: First Report of Collaborative Ocular Oncology Group Study No. 2 (COOG2.1). J Clin Oncol 2024:JCO2400447. [PMID: 39052972 DOI: 10.1200/jco.24.00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Validated and accurate prognostic testing is critical for precision medicine in uveal melanoma (UM). Our aims were to (1) prospectively validate an integrated prognostic classifier combining a 15-gene expression profile (15-GEP) and PRAME RNA expression and (2) identify clinical variables that enhance the prognostic accuracy of the 15-GEP/PRAME classifier. MATERIALS AND METHODS This study included 1,577 patients with UM of the choroid and/or ciliary body who were enrolled in the Collaborative Ocular Oncology Group Study Number 2 (COOG2) and prospectively monitored across 26 North American centers. Test results for 15-GEP (class 1 or class 2) and PRAME expression status (negative or positive) were available for all patients. The primary end point was metastasis-free survival (MFS). RESULTS 15-GEP was class 1 in 1,082 (68.6%) and class 2 in 495 (31.4%) patients. PRAME status was negative in 1,106 (70.1%) and positive in 471 (29.9%) patients. Five-year MFS was 95.6% (95% CI, 93.9 to 97.4) for class 1/PRAME(-), 80.6% (95% CI, 73.9 to 87.9) for class 1/PRAME(+), 58.3% (95% CI, 51.1 to 66.4) for class 2/PRAME(-), and 44.8% (95% CI, 37.9 to 52.8) for class 2/PRAME(+). By multivariable Cox proportional hazards analysis, 15-GEP was the most important independent predictor of MFS (hazard ratio [HR], 5.95 [95% CI, 4.43 to 7.99]; P < .001), followed by PRAME status (HR, 1.82 [95% CI, 1.42 to 2.33]; P < .001). The only clinical variable demonstrating additional prognostic value was tumor diameter. CONCLUSION In the largest prospective multicenter prognostic biomarker study performed to date in UM to our knowledge, the COOG2 study validated the superior prognostic accuracy of the integrated 15-GEP/PRAME classifier over 15-GEP alone and clinical prognostic variables. Tumor diameter was found to be the only clinical variable to provide additional prognostic information. This prognostic classifier provides an advanced resource for risk-adjusted metastatic surveillance and adjuvant trial stratification in patients with UM.
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Affiliation(s)
- J William Harbour
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Zelia M Correa
- Bascom Palmer Eye Institute and Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | | | - Prithvi Mruthyunjaya
- Byers Eye Institute, Department of Ophthalmology, Stanford University, Stanford, CA
| | | | - Thomas A Aaberg
- Retina Specialists of Michigan, Foundation for Vision Research, and Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Alison H Skalet
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | | | - Ezekiel Weis
- Department of Ophthalmology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Division of Ophthalmology, Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Canada
| | - Ivana K Kim
- Massachusetts Eye and Ear Infirmary and Department of Ophthalmology, Harvard Medical School, Boston, MA
| | | | - Hakan Demirci
- Kellogg Eye Center and Department of Ophthalmology, University of Michigan, Ann Arbor, MI
| | - Kisha D Piggott
- Department of Ophthalmology and Visual Sciences, Washington University, St Louis, MO
| | - Basil K Williams
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH
| | - Eugene Shildkrot
- Department of Ophthalmology, University of Virginia, Charlottesville, VA
| | | | - Scott C Oliver
- Sue Anschutz-Rodgers Eye Center and Department of Ophthalmology, University of Colorado, Aurora, CO
| | - Scott D Walter
- Retina Consultants, Hartford, CT
- Helen and Harry Gray Cancer Center, Hartford, CT
| | - John Mason
- Department of Ophthalmology, University of Alabama, Birmingham, AL
| | | | - Michael Altaweel
- Department of Ophthalmology, University of Wisconsin, Madison, WI
| | - Jill R Wells
- Department of Ophthalmology, Emory University, Atlanta, GA
| | - Jay S Duker
- New England Eye Center and Department of Ophthalmology, Tufts University, Boston, MA
| | | | - Dan S Gombos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tony Tsai
- Retinal Consultants Medical Group, Sacramento, CA
| | | | - Brian P Marr
- Department of Ophthalmology, Columbia University, New York, NY
| | - Ang Gao
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
- O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christina L Decatur
- Bascom Palmer Eye Institute and Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - James J Dollar
- Bascom Palmer Eye Institute and Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Stefan Kurtenbach
- Bascom Palmer Eye Institute and Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Song Zhang
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
- O'Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Sacco JJ, Carvajal RD, Butler MO, Shoushtari AN, Hassel JC, Ikeguchi A, Hernandez-Aya L, Nathan P, Hamid O, Piulats JM, Rioth M, Johnson DB, Luke JJ, Espinosa E, Leyvraz S, Collins L, Holland C, Sato T. Long-term survival follow-up for tebentafusp in previously treated metastatic uveal melanoma. J Immunother Cancer 2024; 12:e009028. [PMID: 38844408 PMCID: PMC11163599 DOI: 10.1136/jitc-2024-009028] [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] [Accepted: 04/19/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Tebentafusp, a bispecific (gp100×CD3) ImmTAC, significantly improved overall survival (OS) outcomes for HLA-A*02:01+ adult patients with untreated metastatic uveal melanoma (mUM) and showed promising survival in previously treated mUM with 1-year OS of 62% in the primary analysis of study IMCgp100-102. Here we report long-term outcomes from this phase 1/2 study in pretreated mUM. PATIENTS AND METHODS Patients with previously treated mUM received tebentafusp weekly intravenous at 20 µg dose 1, 30 µg dose 2 and either 54, 64, 68, or 73 µg (phase 1) or 68 µg (phase 2) dose 3+. The primary objective was overall response rate. Secondary objectives included OS and safety. OS was estimated by Kaplan-Meier methods. Association between OS and baseline covariates, on-treatment Response Evaluation Criteria in Solid Tumors (RECIST) response, baseline tumor biopsy and circulating-tumor DNA (ctDNA) changes were assessed. RESULTS 146 patients were treated with tebentafusp: 19 in phase 1 and 127 in phase 2. With a median follow-up duration of 48.5 months, the median OS was 17.4 months (95% CI, 13.1 to 22.8), and the 1-year, 2-year, 3-year and 4-year OS rates were 62%, 40%, 23% and 14%, respectively. Improved survival was associated with lower ctDNA baseline levels and greater ctDNA reductions by week 9 on-treatment, with 100% 1-year, 73% 2-year and 45% 3-year OS rates for patients with ctDNA clearance. Baseline gp100 expression was not associated with survival, despite more RECIST responses among patients with higher expression. No new safety signals were reported with long-term dosing. CONCLUSIONS This study represents the longest follow-up of a Tcell receptor bispecific to date and confirms the durable survival benefits achieved with tebentafusp in previously treated mUM with good tolerability long-term. A role for ctDNA reduction as an early indicator of clinical benefit was again suggested for patients treated with tebentafusp.
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Affiliation(s)
- Joseph J Sacco
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
- University of Liverpool, Liverpool, Merseyside, UK
| | - Richard D Carvajal
- Northwell Health Cancer Institute, New York, New York, USA
- Cold Spring Harbor Laboratory Cancer Center, Cold Spring Harbor, New York, USA
| | - Marcus O Butler
- Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Alexandra Ikeguchi
- The University of Oklahoma Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Paul Nathan
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Omid Hamid
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Santa Monica, California, USA
| | - Josep M Piulats
- Catalan Cancer Institute (ICO) de l'Hospitalet - ProCure Program, Barcelona, Spain
- Cancer Immunotherapy Group, Institut de Recerca Biomedica de Bellvitge (IDIBELL) - OncoBell, Barcelona, Spain
| | - Matthew Rioth
- UC Cancer Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Jason J Luke
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Serge Leyvraz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Takami Sato
- Sidney Kimmel Cancer Center, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
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3
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Arang N, Lubrano S, Ceribelli M, Rigiracciolo DC, Saddawi-Konefka R, Faraji F, Ramirez SI, Kim D, Tosto FA, Stevenson E, Zhou Y, Wang Z, Bogomolovas J, Molinolo AA, Swaney DL, Krogan NJ, Yang J, Coma S, Pachter JA, Aplin AE, Alessi DR, Thomas CJ, Gutkind JS. High-throughput chemogenetic drug screening reveals PKC-RhoA/PKN as a targetable signaling vulnerability in GNAQ-driven uveal melanoma. Cell Rep Med 2023; 4:101244. [PMID: 37858338 PMCID: PMC10694608 DOI: 10.1016/j.xcrm.2023.101244] [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: 02/21/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Uveal melanoma (UM) is the most prevalent cancer of the eye in adults, driven by activating mutation of GNAQ/GNA11; however, there are limited therapies against UM and metastatic UM (mUM). Here, we perform a high-throughput chemogenetic drug screen in GNAQ-mutant UM contrasted with BRAF-mutant cutaneous melanoma, defining the druggable landscape of these distinct melanoma subtypes. Across all compounds, darovasertib demonstrates the highest preferential activity against UM. Our investigation reveals that darovasertib potently inhibits PKC as well as PKN/PRK, an AGC kinase family that is part of the "dark kinome." We find that downstream of the Gαq-RhoA signaling axis, PKN converges with ROCK to control FAK, a mediator of non-canonical Gαq-driven signaling. Strikingly, darovasertib synergizes with FAK inhibitors to halt UM growth and promote cytotoxic cell death in vitro and in preclinical metastatic mouse models, thus exposing a signaling vulnerability that can be exploited as a multimodal precision therapy against mUM.
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Affiliation(s)
- Nadia Arang
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA 92093, USA; Department of Pharmacology, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Simone Lubrano
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Department of Pharmacy, University of Pisa, Pisa, Italy
| | - Michele Ceribelli
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | | | | | - Farhoud Faraji
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Sydney I Ramirez
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Daehwan Kim
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Department of Pharmacology, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Frances A Tosto
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Erica Stevenson
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA 94158, USA; J. David Gladstone Institutes, San Francisco, CA 94158, USA; Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Yuan Zhou
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA 94158, USA; J. David Gladstone Institutes, San Francisco, CA 94158, USA; Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Zhiyong Wang
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Julius Bogomolovas
- School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Alfredo A Molinolo
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA
| | - Danielle L Swaney
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA 94158, USA; J. David Gladstone Institutes, San Francisco, CA 94158, USA; Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Nevan J Krogan
- Quantitative Biosciences Institute (QBI), University of California San Francisco, San Francisco, CA 94158, USA; J. David Gladstone Institutes, San Francisco, CA 94158, USA; Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, CA 94158, USA
| | - Jing Yang
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Department of Pharmacology, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
| | | | | | - Andrew E Aplin
- Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Dario R Alessi
- Medical Research Council (MRC) Protein Phosphorylation and Ubiquitylation Unit, School of Life Sciences, University of Dundee, Dundee DD1 5EH, UK
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - J Silvio Gutkind
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Department of Pharmacology, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA.
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4
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Wespiser M, Neidhardt E, Negrier S. Uveal melanoma: In the era of new treatments. Cancer Treat Rev 2023; 119:102599. [PMID: 37473516 DOI: 10.1016/j.ctrv.2023.102599] [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: 05/13/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Uveal melanoma (UM), also known as choroidal melanoma, is the leading adult intraocular tumor worldwide, affecting mainly Caucasian populations. The last decade has seen an improvement in the outcome of these tumors at the localized stage, in favor of conservative treatment of the eye, notably with new radioactive treatment techniques. Despite optimal management, half of the patients will become metastatic, with liver involvement in 90% of cases. The prognosis is pejorative and considers clinical, tumor anatomy, histological and molecular parameters. This review provides a broad overview of the different therapeutic options for the management of localized or metastatic UM disease, with recently updated data. Despite the known limited efficacy of chemotherapy and immune checkpoint inhibitors (ICI), we discuss the first results of combined immunotherapies, the arrival of a new first-in-class immunomodulatory treatment Tebentafusp, in HLA-A*02:01 patients, avenues of research into targeted anti-tyrosine kinase therapies, and the growing use of ctDNA to guide treatment prescription.
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Affiliation(s)
- M Wespiser
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France.
| | - E Neidhardt
- Centre Léon Bérard, University of Lyon, Lyon, France.
| | - S Negrier
- Centre Léon Bérard, University of Lyon, Lyon, France.
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5
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Howlett S, Carter TJ, Shaw HM, Nathan PD. Tebentafusp: a first-in-class treatment for metastatic uveal
melanoma. Ther Adv Med Oncol 2023; 15:17588359231160140. [PMID: 36970111 PMCID: PMC10031621 DOI: 10.1177/17588359231160140] [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: 08/26/2022] [Accepted: 02/06/2023] [Indexed: 03/24/2023] Open
Abstract
Tebentafusp is a first-in-class immunotherapy agent that comprises an engineered
T-cell receptor targeting a gp100 epitope presented by human leukocyte
antigen-A*02:01 cells, fused to an anti-CD3 single-chain variable fragment.
Tebentafusp is both the first bispecific T-cell engager to show efficacy in the
treatment of advanced solid cancer and the first anti-cancer treatment to
demonstrate an overall survival benefit in patients with uveal melanoma (UM).
This review article will focus on the clinical development of tebentafusp, the
mechanism of action and resultant evolution of the management of advanced
UM.
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Affiliation(s)
- Sarah Howlett
- Mount Vernon Cancer Centre, Northwood,
Middlesex, UK
| | | | - Heather M. Shaw
- Mount Vernon Cancer Centre, Northwood,
Middlesex, UK
- University College London Hospital, London,
UK
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6
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Targeting IRS-1/2 in Uveal Melanoma Inhibits In Vitro Cell Growth, Survival and Migration, and In Vivo Tumor Growth. Cancers (Basel) 2022; 14:cancers14246247. [PMID: 36551732 PMCID: PMC9777326 DOI: 10.3390/cancers14246247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Uveal melanoma originating in the eye and metastasizing to the liver is associated with poor prognosis and has only one approved therapeutic option. We hypothesized that liver-borne growth factors may contribute to UM growth. Therefore, we investigated the role of IGF-1/IGF-1R signaling in UM. Here, we found that IRS-1, the insulin receptor substrate, is overexpressed in both UM cells and tumors. Since we previously observed that IGF-1R antibody therapy was not clinically effective in UM, we investigated the potential of NT157, a small molecule inhibitor of IRS-1/2, in blocking this pathway in UM. NT157 treatment of multiple UM cell lines resulted in reduced cell growth and migration and increased apoptosis. This treatment also significantly inhibited UM tumor growth in vivo, in the chicken egg chorioallantoic membrane (CAM) and subcutaneous mouse models, validating the in vitro effect. Mechanistically, through reverse phase protein array (RPPA), we identified significant proteomic changes in the PI3K/AKT pathway, a downstream mediator of IGF-1 signaling, with NT157 treatment. Together, these results suggest that NT157 inhibits cell growth, survival, and migration in vitro, and tumor growth in vivo via inhibiting IGF-1 signaling in UM.
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7
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Wei AZ, Uriel M, Porcu A, Manos MP, Mercurio AC, Caplan MM, Hulse L, Seedor RS, Holovatska M, Francis J, Khan SA, McDonnell DE, Bogomolny D, Sato T, Marr BP, Haq R, Orloff M, Shoushtari A, Carvajal RD. Characterizing metastatic uveal melanoma patients who develop symptomatic brain metastases. Front Oncol 2022; 12:961517. [PMID: 36212499 PMCID: PMC9540230 DOI: 10.3389/fonc.2022.961517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Metastatic uveal melanoma (mUM) is an advanced ocular malignancy characterized by a hepatotropic pattern of spread. As the incidence of brain metastases (BM) in mUM patients has been thought to be low, routine CNS surveillance has not been recommended. Notably, no formal assessment of BM incidence in mUM has to date been published to support this clinical practice. We aimed to determine the true rate of BM in mUM and to clarify the clinical and genomic risk factors associated with BM patients through a collaborative multicenter, retrospective research effort. Data collected from 1,845 mUM patients in databases across four NCI-designated comprehensive cancer centers from 2006-2021 were retrospectively analyzed to identify patients with BM. Brain imaging in most cases were performed due to onset of neurological symptoms and not for routine surveillance. An analysis of demographics, therapies, gene expression profile, tumor next generation sequencing (NGS) data, time to metastasis (brain or other), and survival in the BM cohort was completed. 116/1,845 (6.3%) mUM patients were identified with BM. The median age at time of UM diagnosis was 54 years old (range: 18-77). The median time to any metastasis was 4.2 years (range: 0-30.8). The most common initial metastatic site was the liver (75.9%). 15/116 (12.9%) BM patients presented with BM at the time of initial metastatic diagnosis. Median survival after a diagnosis of BM was 7.6 months (range: 0.4-73.9). The median number of organs involved at time of BM diagnosis was 3 (range: 1-9). DecisionDX-UM profiling was completed on 13 patients: 10-Class 2, 2-Class 1B, and 1-Class 1A. NGS and cytogenetic data were available for 34 and 21 patients, respectively. BM was identified in 6.3% of mUM cases and was associated with high disease burden and a median survival of under 8 months once diagnosed. Since most patients in this cohort were symptomatic, the incidence of asymptomatic BM remains unknown. These data suggest the use of routine brain imaging in all mUM patients at risk for developing BM for early detection.
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Affiliation(s)
- Alexander Z. Wei
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Matan Uriel
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Agata Porcu
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Ann C. Mercurio
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Michael M. Caplan
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Liam Hulse
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Rino S. Seedor
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Jasmine Francis
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shaheer A. Khan
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Diana E. McDonnell
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Dmitry Bogomolny
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Takami Sato
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Brian P. Marr
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
| | - Rizwan Haq
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marlana Orloff
- Department of Medical Oncology Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | | | - Richard D. Carvajal
- Division of Hematology & Oncology Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Richard D. Carvajal,
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8
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Recent Advances and Challenges in Uveal Melanoma Immunotherapy. Cancers (Basel) 2022; 14:cancers14133094. [PMID: 35804863 PMCID: PMC9264803 DOI: 10.3390/cancers14133094] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Uveal melanoma is the most common primary intraocular malignancy in adults. Although it can be controlled locally, half of the patients still develop metastases. To date, there have been no standard therapeutic strategies for the prevention or treatment of metastases. Existing therapies, such as chemotherapy and targeted therapies, induce only minimal responses. This review focuses on newly published research on immunotherapy. We highlight expanding treatments and their clinical outcomes, as well as propose promising new treatments and feasible checkpoints. Based on these findings, we provide innovative insights into feasible strategies for the treatment of patients with uveal melanoma. Abstract Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Compared to cutaneous melanoma (CM), which mainly harbors BRAF or NRAS mutations, UM predominantly harbors GNAQ or GNA11 mutations. Although primary UM can be controlled locally, approximately 50% of patients still develop metastases. To date, there have been no standard therapeutic strategies for the prevention or treatment of metastases. Unfortunately, chemotherapy and targeted therapies only induce minimal responses in patients with metastatic UM, with a median survival time of only 4–5 months after metastasis detection. Immunotherapy agents, such as immune checkpoint inhibitors, have achieved pioneering outcomes in CM but have shown limited effects in UM. Researchers have explored several feasible checkpoints to identify options for future therapies. Cancer vaccines have shown little in the way of therapeutic benefit in patients with UM, and there are few ongoing trials providing favorable evidence, but adoptive cell transfer-related therapies seem promising and deserve further investigation. More recently, the immune-mobilizing monoclonal T-cell receptor against the cancer molecule tebentafusp showed impressive antitumor effects. Meanwhile, oncolytic viruses and small molecule inhibitors have also gained ground. This review highlights recent progress in burgeoning treatments and provides innovative insights on feasible strategies for the treatment of UM.
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