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Prieto-Domínguez L, García-Álvarez C, Muñoz-Moreno MF, Diezhandino P, Miguel-Perez D, Saornil MA. Long Term Follow-Up Observation in Small Choroidal Melanocytic Tumors. Cancers (Basel) 2024; 16:2627. [PMID: 39123355 PMCID: PMC11311257 DOI: 10.3390/cancers16152627] [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: 06/27/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The purpose of this study is to analyze the long-term evolution of patients with small choroidal melanocytic tumors (SCMTs) undergoing observation, and to assess their rate of transformation into melanomas and survival. METHODS A retrospective single-cohort study of patients with SCMTs (1-3 mm in height and 5-10 mm in base) diagnosed from January 1992 to February 2023 was carried out, with observation as the initial treatment. The main criterion for a transformation into melanoma is considered to be an increase in size of more than 1 mm in height and/or more than 1 mm in base measured on an ultrasound/retinography, recorded in two consecutive visits separated by one to three months. RESULTS 243 patients were included with a mean age of 65.3 years and a mean follow-up of 7.9 years (6 months-27.9 years); 27 patients showed tumor growth. The probabilities of growth at 5, 10, and 15 years are 10%, 14%, and 17%, respectively. Regarding survival, 22 patients died and only 3 deaths were due to melanoma metastasis. Survival rates at 5 and 10 years are 99% and 97%. CONCLUSIONS Observation is a viable therapeutic option for SCMTs, avoiding the side effects of treatment, considering the majority of these tumors do not progress to melanoma. With close monitoring, patients can be treated promptly upon detecting a transformation. Additionally, the findings confirm that small melanocytic tumors can lead to metastatic disease, albeit at a low rate.
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Affiliation(s)
- Laura Prieto-Domínguez
- Ophtalmology Department, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 47003 Valladolid, Spain
| | - Ciro García-Álvarez
- Ophtalmology Department, Ocular Oncology Unit, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 47003 Valladolid, Spain;
| | - Maria F. Muñoz-Moreno
- Research Support Unit, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain;
| | - Patricia Diezhandino
- Radiation Oncology Department, Ocular Oncology Unit, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 47003 Valladolid, Spain;
| | - David Miguel-Perez
- Radiophysics Department, Ocular Oncology Unit, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 47003 Valladolid, Spain;
| | - María A. Saornil
- Ophtalmology Department, Ocular Oncology Unit, University Clinical Hospital of Valladolid, Avenida Ramón y Cajal, 47003 Valladolid, Spain;
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Noureldine AM, Hamza H, Khattab AM, Macky TA, Hassanein DH, Abdullatif AM, Salem DS, Salah SH. B-scan measurements of intraocular tumor heights intraoperatively, before and after radioactive plaque application: A comparative prospective study. J Fr Ophtalmol 2024; 47:103941. [PMID: 37730496 DOI: 10.1016/j.jfo.2023.04.009] [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: 12/23/2022] [Revised: 03/14/2023] [Accepted: 04/05/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE To assess the difference in intraocular tumors height measurements intraoperatively before and after radioactive plaque application. METHODOLOGY Twenty-four eyes of 24 patients with intraocular tumors, candidates for radioactive therapy, were included. Each tumor was measured at the same setting before and after plaque application independently by 3 sonographers, using a 20-MHz B-scan transducer. Mean pre-plaque and post-plaque measurements were calculated and recorded. An A-scan vector aided in identification of the inner and outer tumor surfaces. RESULTS Each patient was examined independently three times by three experienced ultrasonographers within the same setting to assess interobserver variability. There was no statistically significant difference between the 3 examiners' readings, with P-value 0.99 for pre-plaque height and 0.97 for post-plaque height. Mean pre-plaque height was 5.16±2.11mm, while post-plaque height was 5.51±2.1mm (P-value 0.001). The Spearman correlation test showed that initial tumor height was negatively correlated with the difference between both heights, but with no statistical significance. CONCLUSION Intraocular tumor height measurement differs significantly before and after plaque application. Use of the pre-plaque height is advised until further studies are performed to assess the effect of this difference on treatment outcomes.
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Affiliation(s)
| | - H Hamza
- Faculty of medicine, Cairo university, Cairo, Egypt
| | - A M Khattab
- Faculty of medicine, Cairo university, Cairo, Egypt
| | - T A Macky
- Faculty of medicine, Cairo university, Cairo, Egypt
| | | | | | - D S Salem
- Faculty of medicine, Cairo university, Cairo, Egypt
| | - S H Salah
- Faculty of medicine, Cairo university, Cairo, Egypt
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Chen M, Hu J, Gao H, Shen J, Wei T, Yao J, Zhang Y, Gu P, Liu Z, Chen Q. An immunotherapeutic artificial vitreous body hydrogel to control choroidal melanoma and preserve vision after vitrectomy. SCIENCE ADVANCES 2023; 9:eadh1582. [PMID: 37910617 PMCID: PMC10619924 DOI: 10.1126/sciadv.adh1582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023]
Abstract
Choroidal melanoma, a common intraocular malignant tumor, relies on local radiotherapy and enucleation for treatment. However, cancer recurrence and visual impairment remain important challenges. Here, a therapeutic artificial vitreous body (AVB) hydrogel based on tetra-armed poly(ethylene glycol) was developed to control the recurrence of choroidal melanoma and preserve vision after vitrectomy. AVB loaded with melphalan (Mel) and anti-programmed cell death ligand-1 (αPDL1), was injected after surgical resection in the choroidal melanoma mouse model. Afterwards, the sequentially released Mel and αPDL1 from AVB could achieve a synergistic antitumor effect to inhibit tumor recurrence. AVB with similar physical properties to native vitreous body could maintain the normal structure and visual function of eye after vitrectomy, which has been evidenced by standard examinations of ophthalmology in the mouse model. Thus, the immunotherapeutic AVB may be a promising candidate as an infill biomaterial to assist surgical treatment of intraocular malignant tumors.
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Affiliation(s)
- Muchao Chen
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
| | - Jiaying Hu
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
| | - Huiqin Gao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, P.R. China
| | - Jingjing Shen
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
| | - Ting Wei
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
| | - Jing Yao
- Department of Ophthalmology and Vision Science, Eye & ENT Hospital, Shanghai Medical School, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Yan Zhang
- Department of Orthopedics, Shanghai Yangpu Hospital Affiliated to Tongji University, Shanghai 200090, China
| | - Ping Gu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, P.R. China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai 200011, P.R. China
| | - Zhuang Liu
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
| | - Qian Chen
- Institute of Functional Nano and Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon Based Functional Materials and Devices, Soochow University, 199 Ren’ai Road, Suzhou, Jiangsu 215123, P.R. China
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Velez G, Wolf J, Dufour A, Mruthyunjaya P, Mahajan VB. Cross-Platform Identification and Validation of Uveal Melanoma Vitreous Protein Biomarkers. Invest Ophthalmol Vis Sci 2023; 64:14. [PMID: 37955612 PMCID: PMC10653261 DOI: 10.1167/iovs.64.14.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose The purpose of this study was to profile protein expression liquid vitreous biopsies from patients with uveal melanoma (UM) using mass spectrometry to identify prognostic biomarkers, signaling pathways, and therapeutic targets. Methods Vitreous biopsies were collected from two cohorts in a pilot study: comparative control eyes with epiretinal membranes (ERM; n = 3) and test eyes with UM (n = 8). Samples were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Identified proteins were compared to data from a targeted multiplex ELISA proteomics platform. Results A total of 69 significantly elevated proteins were detected in the UM vitreous, including LYVE-1. LC-MS/MS identified 62 significantly upregulated proteins in UM vitreous that were not previously identified by ELISA. Analysis of differential protein expression by tumor molecular classification (gene expression profiling [GEP] and preferentially expressed antigen in melanoma [PRAME]) further identified proteins that correlated with these classifications. Patients with high-risk GEP tumors displayed elevated vitreous expression of HGFR (fold-change [FC] = 2.66E + 03, P value = 0.003) and PYGL (FC = 1.02E + 04, P = 1.72E-08). Patients with PRAME positive tumors displayed elevated vitreous expression of ENPP-2 (FC = 3.21, P = 0.04), NEO1 (FC = 2.65E + 03, P = 0.002), and LRP1 (FC = 5.59E + 02, P value = 0.01). IGF regulatory effectors were highly represented (P value = 1.74E-16). Cross-platform analysis validated seven proteins identified by ELISA and LC-MS/MS. Conclusions Proteomic analysis of liquid biopsies may provide prognostic information supporting gene expression of tumor biopsies. The use of multiple protein detection platforms in the same patient samples increases the sensitivity of candidate biomarker detection and allows for precise characterization of the vitreous proteome.
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Affiliation(s)
- Gabriel Velez
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, United States
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Julian Wolf
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, United States
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Antoine Dufour
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Vinit B. Mahajan
- Molecular Surgery Laboratory, Stanford University, Palo Alto, California, United States
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
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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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Madani A, Omar NE, Mustafa G, Petkar M, Mohamed S, Al kuwari M, Karim SA, Mohsen R. Cardiac Metastases from Choroidal Melanoma. Clin Case Rep 2022; 10:e6080. [PMID: 35865765 PMCID: PMC9290777 DOI: 10.1002/ccr3.6080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
In patients with uveal melanoma, cardiac metastases can present without any symptoms. It is becoming more common than previously thought and highlights the importance of routine surveillance after definitive treatment.
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Affiliation(s)
- Ammar Madani
- Department of Medical Oncology, National Centre for Cancer Care and Research Hamad Medical Corporation Doha Qatar
| | - Nabil E. Omar
- Pharmacy Department, National Centre for Cancer Care and Research Hamad Medical Corporation Doha Qatar
| | - Ghulam Mustafa
- Department of Nuclear Medicine, National Centre for Cancer Care and Research Hamad Medical Corporation Doha Qatar
| | - Mahir Petkar
- Department of Pathology Hamad Medical Corporation Doha Qatar
| | - Samah Mohamed
- Department of Radiology Hamad Medical Corporation Doha Qatar
| | | | | | - Reyad Mohsen
- Department of Medical Oncology, National Centre for Cancer Care and Research Hamad Medical Corporation Doha Qatar
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New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma. Cancers (Basel) 2021; 14:cancers14010134. [PMID: 35008296 PMCID: PMC8750035 DOI: 10.3390/cancers14010134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Uveal melanoma is the most common intraocular cancer. The current eye-sparing treatment options include mostly plaque brachytherapy. However, the effectiveness of these methods is still unsatisfactory. In this article, we review several possible new treatment options. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Another approach may be based on improving the penetration of the anti-cancer agents. It seems that the most promising technologies from this group are based on enhancing drug delivery by applying electric current. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced studies on experimental animals and clinical trials would be needed to introduce some of these techniques to routine clinical practice. Abstract Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the choroid, ciliary body, or iris. The current eye-sparing treatment options include surgical treatment, plaque brachytherapy, proton beam radiotherapy, stereotactic photon radiotherapy, or photodynamic therapy. However, the efficacy of these methods is still unsatisfactory. This article reviews several possible new treatment options and their potential advantages in treating localized uveal melanoma. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Two examples of such an approach are High-Intensity Focused Ultrasound (HIFU)—a promising technology of thermal destruction of solid tumors located deep under the skin and sonodynamic therapy (SDT) that induces reactive oxygen species. Another approach may be based on improving the penetration of anti-cancer agents into UM cells. The most promising technologies from this group are based on enhancing drug delivery by applying electric current. One such approach is called transcorneal iontophoresis and has already been shown to increase the local concentration of several different therapeutics. Another technique, electrically enhanced chemotherapy, may promote drug delivery from the intercellular space to cells. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced and targeted preclinical studies and clinical trials would be needed to introduce some of these techniques to routine clinical practice.
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Tanke LB, Leske DA, Dalvin LA. Conversion Factor for B-Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1911-1917. [PMID: 33274784 DOI: 10.1002/jum.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the relationship between choroidal nevus and melanoma thickness measured with or without the sclera included by B-scan ultrasound and to present a simple conversion formula. METHODS Medical records were retrospectively reviewed for choroidal nevus or melanoma evaluated at the Mayo Clinic in Rochester, Minnesota, with B-scan ultrasound between February 4, 2004, and April 23, 2020. Charts were retrospectively reviewed for high-quality B-scan images in which the ultrasound transducer was perpendicular to the lesion, measuring the tumor thickness without the sclera included. Measurements were repeated with the sclera included for each patient. Univariate and multiple linear regression analyses were performed to identify factors correlated with scleral thickness. RESULTS There were 201 tumors included in the study, with a mean patient age ± SD of 61 ± 14 years, largest tumor basal diameter of 11.8 ± 4.8 mm, tumor thickness without the sclera included of 3.72 ± 2.7 mm, and thickness with the sclera included of 4.54 ± SD 2.8 mm. On the univariate analysis, factors associated with perceived scleral thickness by B-scan ultrasound included age (P < .001), tumor thickness (P < .001), and basal diameter (P = .06). On the multivariate analysis, factors associated with perceived scleral thickness included age and tumor thickness (P < .001) for all tumors and for the subset of 141 tumors with a thickness of 2 mm or greater (P < .001). For tumors of 2 mm or greater in thickness, perceived scleral thickness by ultrasound can be estimated by the formula 0.00495(patient age) + 0.02451(tumor thickness without the sclera) + 0.42549. CONCLUSIONS We present a simple formula for converting between B-scan ultrasound measurements of choroidal nevus and melanoma measuring 2 mm or greater in thickness with and without the sclera included.
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Affiliation(s)
- Laurel B Tanke
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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SOLAK M, KILIÇKAP S, CELIK İ. Retrospective evaluation of malignant melanoma patients: A single-center experience. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.717911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Miguel D, Saornil MA, de Frutos JM, García-Álvarez C, Alonso P, Diezhandino P. Regression of posterior uveal melanoma following iodine-125 plaque radiotherapy based on pre-treatment tumor apical height. J Contemp Brachytherapy 2021; 13:117-125. [PMID: 33897784 PMCID: PMC8060957 DOI: 10.5114/jcb.2021.105278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to analyze regression rates and local control of uveal melanoma patients treated with iodine-125 ( 125I) brachytherapy based on initial tumor apical height. MATERIAL AND METHODS Patients treated in a single institution from January 1st, 1996 to 2019 with 125I plaques (ROPES and COMS) for uveal melanoma were included in this study. Patients treated with brachytherapy for iris and those treated with transpupillary thermotherapy prior to brachytherapy were excluded. The sample was classified into 4 categories depending on initial apical tumor height (h0), i.e., h0 ≤ 2.5 (small), 2.5 < h0 ≤ 6.25 (small-medium), 6.25 < h0 ≤ 10 (medium-large), and h0 > 10 mm (large). Percentage of original tumor apical height (Δh) was collected during follow-ups. Patterns of regression were evaluated using linear least squares adjustments. Multivariable Cox regression were performed. RESULTS In total, 305 patients met the inclusion criteria, and 27, 166, 100, and 13 were considered for small, small-medium, medium-large, and large categories, respectively. Median follow-up was 82.4, 56.8, 76.1, 89.1, and 100.1 months for the entire cohort and each sub-group, respectively. Pattern of decrease when h0 ≤ 2.5 mm was not detectable. For the rest sub-groups, changes in height could be fitted using functional form: Δh (T) = ae-bT + c, R 2 ≥ 0.97. Multivariate Cox analysis factors predictive of local control failure revealed a hazard ratio (HR) of 6.1 (95% CI: 0.7-58.2%, p = 0.05) for patients who remained similar sized after treatment for small-medium tumors. For the rest sub-groups, Cox analysis did not indicate statistical significance in any single variable. CONCLUSIONS Height changes can be modeled by a negative exponential function for the first 7 years after treatment depending on the initial height, except for those less than 2.5 mm. Non-responding small-medium tumors multiply by 6 the probability of failure in local control.
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Affiliation(s)
- David Miguel
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
| | | | | | | | - Pilar Alonso
- Intraocular Tumors Unit, Valladolid University Hospital, Valladolid, Spain
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Santos-Buitrago B, Santos-García G, Hernández-Galilea E. Artificial intelligence for modeling uveal melanoma. Artif Intell Cancer 2020; 1:51-65. [DOI: 10.35713/aic.v1.i4.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
Understanding of the cellular signaling pathways involved in cancer disease is of great importance. These complex biological mechanisms can be thoroughly revealed by their structure, dynamics, and control methods. Artificial intelligence offers rule-based models that favor the research of human signaling processes. In this paper, we give an overview of the advantages of the formalism of symbolic models in medical biology and cell biology of the uveal melanoma. A language is described that allows us: (1) To define the system states and elements with their alterations; (2) To model the dynamics of the cellular system; and (3) To perform inference-based analysis with the logical tools of the language.
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Affiliation(s)
| | - Gustavo Santos-García
- IME, University of Salamanca, Salamanca 37007, Spain
- FADoSS Research Unit, Universidad Complutense de Madrid, Madrid 28040, Spain
| | - Emiliano Hernández-Galilea
- Department of Ophthalmology, Institute of Biomedicine Investigation of Salamanca (IBSAL), University Hospital of Salamanca, University of Salamanca, Salamanca 37007, Spain
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Xu A, Chen C. Clinical application of ultra-widefield fundus autofluorescence. Int Ophthalmol 2020; 41:727-741. [PMID: 33040254 DOI: 10.1007/s10792-020-01609-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To review the basic principles of ultra-widefield fundus autofluorescence (UWF-FAF) and discuss its clinical application for a variety of retinal and choroidal disorders. METHODS A systematic review of the PubMed database was performed using the search terms "ultra-widefield," "autofluorescence," "retinal disease" and "choroidal disease." RESULTS UWF-FAF imaging is a recently developed noninvasive retinal imaging modality with a wide imaging range that can locate peripheral fundus lesions that traditional fundus autofluorescence cannot. Multiple commercially available ultra-widefield imaging systems, including Heidelberg Spectralis and Optomap Ultra-Widefield systems, are available to the clinician. Imaging by UWF-FAF is more comprehensive; it can reflect the content and distribution of the predominant ocular fluorophore in retinal pigment epithelial cells and evaluate the metabolic status of RPE of various retinal and choroidal disorders. CONCLUSION UWF-FAF can detect abnormalities that traditional fundus autofluorescence cannot; therefore, it can be used to better elucidate disease pathogenesis, analyze genotype-phenotype correlations, diagnose and monitor disease.
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Affiliation(s)
- Amin Xu
- Department of Ophthalmology of Renmin Hospital of Wuhan University, No238, Jiefang Road, Wuhan, 430060, Hubei, China
| | - Changzheng Chen
- Department of Ophthalmology of Renmin Hospital of Wuhan University, No238, Jiefang Road, Wuhan, 430060, Hubei, China.
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Sahu S, Bhutia TW, Shrestha V, Singh SK, Puri LR. Large choroidal melanoma presenting as neovascular glaucoma. GMS OPHTHALMOLOGY CASES 2019; 9:Doc19. [PMID: 31293875 PMCID: PMC6607447 DOI: 10.3205/oc000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Choroidal melanoma is a relatively rare tumour with a poor prognosis, though it is the most common primary malignancy of the eye among adults. Choroidal melanoma has been reported to present as acute angle closure glaucoma, secondary glaucoma, chronic uveitis, cataract, and staphyloma. We report a case of a28-year-old male presenting with features of neovascular glaucoma in the right eye and having initially been treated with anti-glaucoma medications. However, ultrasonography revealed a mushroom-shaped, elevated, solid lesion with low to moderate internal reflectivity and regular internal structure suggestive of choroidal melanoma. Histopathological examination along with the immunohistochemistry studies of the lesion following enucleation of the eye confirmed the diagnosis of malignant choroidal melanoma. We highlight with this case that large choroidal melanoma may rarely present with features of neovascular glaucoma. The etiology of neovascular glaucoma should be investigated carefully and a potentially life-threatening intraocular tumour should be excluded, although it is a rare presentation.
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Affiliation(s)
- Sabin Sahu
- Sagarmatha Choudhary Eye Hospital, Siraha, Nepal,*To whom correspondence should be addressed: Sabin Sahu, Sagarmatha Choudhary Eye Hospital, Lahan - 3, Siraha, Nepal, Phone: +977-33-560402, E-mail:
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Upon possibilities of simultaneously “radical and sparing” endovitreal removal of choroidal melanoma. OPHTHALMOLOGY JOURNAL 2018. [DOI: 10.17816/ov11357-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Relevance. The endoresection of the choroidal melanoma (CM) is carried out from its top to the base with the formation of surgical coloboma within the healthy choroid visible in the operating microscope, which does not guarantee the absence of residual tumor cells in it at the microscopic level. Excision of the choroid with a large amount of healthy tissues leads to a risk of unnecessary resection of functionally significant tissues with corresponding loss of vision, especially in juxtapapillary and paramacular localization of CM.
Purpose: to develop a method to increase the radicality of endovitreal removal of the choroidal melanoma while achieving the maximum functional result.
Material and methods. At the basis of the “radical and sparing” endovitreal removal of CM lays the principle of micrographic Mohs-surgery used in the treatment of skin cancer. When CM of paramacular localization is mushroom-shaped, the tumor peak often hangs over the macular zone and prevents its visualization and does not allow to determine true boundaries of the CM base in this area. In this situation, it is possible to carry out an endoresection of CM under video endoscopic control.
Results. According to the proposed method, 3 patients were operated: 2 men and 1 woman. All patients in the pre-operative period had exudative retinal detachment, in 1 of them it was vesicular. For the maximum period of observation, all 3 patients are alive, in none of them metastatic lesions and tumor recurrence were detected. All eyes have been preserved. The best corrected visual acuity was: in patient No 1 – 0.3; in patient No 2 – 0.4; in patient No 3 – 0.1.
Conclusion. The proposed treatment method makes possible to carry out the most radical endovitreal removal of CM, which at the same time is sparing for functionally significant healthy surrounding tissues with a decrease in intra- and postoperative complications.
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Brewington BY, Shao YF, Davidorf FH, Cebulla CM. Brachytherapy for patients with uveal melanoma: historical perspectives and future treatment directions. Clin Ophthalmol 2018; 12:925-934. [PMID: 29844657 PMCID: PMC5963830 DOI: 10.2147/opth.s129645] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Surgical management with enucleation was the primary treatment for uveal melanoma (UM) for over 100 years. The Collaborative Ocular Melanoma Study confirmed in 2001 that globe-preserving episcleral brachytherapy for UM was safe and effective, demonstrating no survival difference with enucleation. Today, brachytherapy is the most common form of radiotherapy for UM. We review the history of brachytherapy in the treatment of UM and the evolution of the procedure to incorporate fine-needle-aspiration biopsy techniques with DNA-and RNA-based genetic prognostic testing.
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Affiliation(s)
- Beatrice Y Brewington
- Havener Eye Institute, Department of Ophthalmology and Visual Science, Ohio State University
| | - Yusra F Shao
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Fredrick H Davidorf
- Havener Eye Institute, Department of Ophthalmology and Visual Science, Ohio State University
| | - Colleen M Cebulla
- Havener Eye Institute, Department of Ophthalmology and Visual Science, Ohio State University
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16
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Kanavi MR, Asadi S, Balagholi S, Alikarami F, Nosrati H, Ahmadieh H. Gamma irradiation of ocular melanoma and lymphoma cells in the presence of gold nanoparticles: in vitro study. J Appl Clin Med Phys 2018; 19:268-275. [PMID: 29707895 PMCID: PMC5978644 DOI: 10.1002/acm2.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 12/13/2022] Open
Abstract
The aim of this work was to determine whether conjugation of cultivated choroidal melanoma and Burkitt's lymphoma cells with gold nanoparticles (GNPs) is beneficial for these series of ocular cancer patients. GNPs are radiosensitizers and can sensitize tumors to radiotherapy.This application has been examined in several tumor types, but not in choroidal melanoma. This study shows the results of in vitro study on the choroidal melanoma and also Burkitt's lymphoma cells in the presence of GNPs during continuous gamma irradiation. Cytotoxicity of GNPs were assessed for five different concentrations then cultured melanoma and Burkitt's lymphoma cells were irradiated with a Gamma source in the presence and absence of NPs. Incubation of melanoma cells with GNP concentrations below 100 μg/ml, accompanied by gamma irradiation, increased cell death (P value = 0.016) . In the absence of irradiation, GNPs at these concentrations did not affect cultured melanoma cell metabolism. Reduced cell viability resulted from a significant increase in absorbed energy by the tumor. Moreover, GNP concentrations higher than 200 μg/ml induced cytotoxicity in melanoma cells. Cytotoxicity assay in GNPs-loaded Burkitt's lymphoma cells showed a slight decrease in cell viability at 50 μg/ml and clear cytotoxicity at concentrations higher than 100 μg/ml (P value = 0.035). Concentration and proper injection doses of GNPs in sensitive tissues such as the human eye are important variables yet to be determined.This is the first report of choroidal melanoma dosimetry performed in the presence of GNPs and provides valuable insights into future therapeutic approaches. Further in vitro study with more different sizes and concentrations is needed to determine the optimum size and concentration before any clinical research in this regard.
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Affiliation(s)
- Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Asadi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophtalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Balagholi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Hematology, Faculty of Allied Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Alikarami
- Department of Hematology, Faculty of Allied Medicine, Iran University of Medical Science, Tehran, Iran
| | - Hassan Nosrati
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophtalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Staibano S, Mascolo M, Tranfa F, Salvatore G, Mignogna C, Bufo P, Nugnes L, Bonavolontà G, De Rosa G. Tumor Infiltrating Lymphocytes in Uveal Melanoma: A Link with Clinical Behavior? Int J Immunopathol Pharmacol 2018. [DOI: 10.1177/205873920601900117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Experimental and clinical evidence indicate that immunological mechanisms might be important in the clinical course of uveal malignant melanoma (UMM). We analyzed the amount and phenotype of tumor infiltrating lymphocytes (TIL) and the expression of the apoptosis-inducing molecule Fas and its ligand, FasL, on tumor cells and TIL in a selected series of UMM with the aim to establish if a correlation between their expression and the clinical behavior of UMM exists. TIL phenotype and Fas/FasL expression were evaluated by immunohistochemistry in 61 cases of formalin-fixed, paraffin-embedded UMM. Results were compared with the follow-up data of patients. Most of the UMM showed a prevalence of CD8+ CD3+ T lymphocytes, or CD4+ and CD8+ cells in equal amounts. UMM showed a variable expression of FasL, ranging from 0 to > 40% of neoplastic cells. Fas was always expressed in TIL, although with a variable extent. A subgroup of UMM showed in TIL a strongly reduced or even absent expression of TCR ζ-chain, involved in activation of T-lymphocytes. This subgroup was characterized by a worse outcome. We hypothesized that an impaired cytotoxic immune response due to the loss of the ζ-chain expression plays a primary role in the biological course of UMM. Our results indicate that the overcoming of the impairment of TCR function may represent a prerequisite for the development of new therapeutic strategies for managing UMM, suggesting that elimination of tumor cells may be possible by activation of cytotoxic cells present within ocular melanomas.
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Affiliation(s)
- S. Staibano
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - M. Mascolo
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - F. Tranfa
- Department of Ophthalmology, University of Naples “Federico II”, Naples
| | - G. Salvatore
- Department of Medicine, University of Naples “Federico II”, Naples
| | - C. Mignogna
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - P. Bufo
- Department of Surgical Sciences, University of Foggia, Foggia, Italy
| | - L. Nugnes
- Department of Biomorphological and Functional Sciences, Pathology Section,
| | - G. Bonavolontà
- Department of Ophthalmology, University of Naples “Federico II”, Naples
| | - G. De Rosa
- Department of Biomorphological and Functional Sciences, Pathology Section,
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Evaluation of dose enhancement in presence of gold nanoparticles in eye brachytherapy by 103Pd source. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:545-553. [DOI: 10.1007/s13246-017-0555-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 05/04/2017] [Indexed: 02/03/2023]
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Yazici G, Kiratli H, Ozyigit G, Sari SY, Cengiz M, Tarlan B, Mocan BO, Zorlu F. Stereotactic Radiosurgery and Fractionated Stereotactic Radiation Therapy for the Treatment of Uveal Melanoma. Int J Radiat Oncol Biol Phys 2017; 98:152-158. [DOI: 10.1016/j.ijrobp.2017.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 12/14/2022]
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Abstract
OBJECTIVE The purpose of this article is to summarize the epidemiologic characteristics, clinical aspects, and radiologic appearance of as well as the management considerations and differential diagnoses for noncutaneous primary melanomas occurring at specific anatomic sites. Primary ocular, sinonasal, meningeal, biliary, adrenal, alimentary tract, and genitourinary melanomas are highlighted. CONCLUSION Noncutaneous primary melanomas are a complex group of malignancies with biologic findings that are unique when compared with findings for cutaneous melanomas. Each noncutaneous primary melanoma has its own specific diagnostic and management challenges, depending on the anatomic location where they arise.
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Abstract
The peripheral retina is the site of pathology in many ocular diseases and ultra-widefield (UWF) imaging is one of the new technologies available to ophthalmologists to manage some of these diseases. Currently, there are several imaging systems used in practice for the purpose of diagnostic, monitoring disease progression or response to therapy, and telemedicine. These include modalities for both adults and pediatric patients. The current systems are capable of producing wide- and UWF color fundus photographs, fluorescein and indocyanine green angiograms, and autofluorescence images. Using this technology, important clinical observations have been made in diseases such as diabetic retinopathy, uveitides, retinal vascular occlusions and tumors, intraocular tumors, retinopathy of prematurity, and age-related macular degeneration. Widefield imaging offers excellent postoperative documentation of retinal detachment surgery. New applications will soon be available to integrate this technology into large volume routine clinical practice.
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Affiliation(s)
| | | | - Igor Kozak
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate. J Contemp Brachytherapy 2016; 8:66-73. [PMID: 26985199 PMCID: PMC4793070 DOI: 10.5114/jcb.2016.57818] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/20/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the outcomes of ruthenium-106 (106Ru) brachytherapy in terms of radiation parameters in patients with thick uveal melanomas. Material and methods Medical records of 51 patients with thick (thickness ≥ 7 mm and < 11 mm) uveal melanoma treated with 106Ru brachytherapy during a ten-year period were reviewed. Radiation parameters, tumor regression, best corrected visual acuity (BCVA), and treatment-related complications were assessed. Results Fifty one eyes of 51 consecutive patients including 25 men and 26 women with a mean age of 50.5 ± 15.2 years were enrolled. Patients were followed for 36.1 ± 26.5 months (mean ± SD). Mean radiation dose to tumor apex and to sclera were 71 (± 19.2) Gy and 1269 (± 168.2) Gy. Radiation dose rates to tumor apex and to sclera were 0.37 (± 0.14) Gy/h and 6.44 (± 1.50) Gy/h. Globe preservation was achieved in 82.4%. Preoperative mean tumor thickness of 8.1 (± 0.9) mm decreased to 4.5 (± 1.6) mm, 3.4 (± 1.4) mm, and 3.0 (± 1.46) mm at 12, 24, and 48 months after brachytherapy (p = 0.03). Four eyes that did not show regression after 6 months of brachytherapy were enucleated. Secondary enucleation was performed in 5 eyes because of tumor recurrence or neovascular glaucoma. Tumor recurrence was evident in 6 (11.8%) patients. Mean Log MAR (magnification requirement) visual acuity declined from 0.75 (± 0.63) to 0.94 (± 0.5) (p = 0.04). Best corrected visual acuity of 20/200 or worse was recorded in 37% of the patients at the time of diagnosis and 61.7% of the patients at last exam (p = 0.04). Non-proliferative and proliferative radiation-induced retinopathy was observed in 20 and 7 eyes. Conclusions Thick uveal melanomas are amenable to 106Ru brachytherapy with less than recommended apex radiation dose and dose rates.
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Reznicek L, Stumpf C, Seidensticker F, Kampik A, Neubauer AS, Kernt M. Role of wide-field autofluorescence imaging and scanning laser ophthalmoscopy in differentiation of choroidal pigmented lesions. Int J Ophthalmol 2014; 7:697-703. [PMID: 25161946 DOI: 10.3980/j.issn.2222-3959.2014.04.21] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/21/2014] [Indexed: 01/15/2023] Open
Abstract
AIM To evaluate the diagnostic properties of wide-field fundus autofluorescence (FAF) scanning laser ophthalmoscope (SLO) imaging for differentiating choroidal pigmented lesions. METHODS A consecutive series of 139 patients were included, 101 had established choroidal melanoma with 13 untreated lesions and 98 treated with radiotherapy. Thirty-eight had choroidal nevi. All patients underwent a full ophthalmological examination, undilated wide-field imaging, FAF and standardized US examination. FAF images and imaging characteristics from SLO were correlated with the structural findings in the two patient groups. RESULTS Mean FAF intensity of melanomas was significantly lower than the FAF of choroidal nevi. Only 1 out of 38 included eyes with nevi touched the optic disc compared to 31 out of 101 eyes with melanomas. In 18 out of 101 melanomas subretinal fluid was seen at the pigmented lesion compared to none seen in eyes with confirmed choroidal nevi. In "green laser separation", a trend towards more mixed FAF appearance of melanomas compared to nevi was observed. The mean maximal and minimal transverse and longitudinal diameters of melanomas were significantly higher than those of nevi. CONCLUSION Wide-field SLO and FAF imaging may be an appropriate non-invasive diagnostic screening tool to differentiate benign from malign pigmented choroidal lesions.
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Affiliation(s)
- Lukas Reznicek
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Carmen Stumpf
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Florian Seidensticker
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Anselm Kampik
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Aljoscha S Neubauer
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
| | - Marcus Kernt
- Department of Ophthalmology, Ludwig Maximilians University Muenchen, Mathildenstr. 8, Munich 80336, Germany
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Abstract
Purpose To describe a case of uveal melanoma in the peripheral choroid masquerading as chronic uveitis and to raise awareness about malignant masquerade syndromes. Case Report A 36-year-old Chinese woman presented from an outside ophthalmologist with a 6-month history of unilateral chronic uveitis unresponsive to medical therapy in the left eye. She was found to have a uveal melanoma in the retinal periphery and underwent successful enucleation of her left eye. The histopathological diagnosis confirmed the clinical diagnosis. Conclusions When uveal melanoma presents in an atypical way, the diagnosis is more difficult. This case highlights the uncommon presentations of malignant melanoma of the choroid. It provides valuable information on how peripheral uveal melanoma can present with clinical signs consistent with an anterior uveitis.
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Modarres M, Rezanejad A, Falavarjani KG. Recurrence and massive extraocular extension of choroidal malignant melanoma after vitrectomy and endoresection. Indian J Ophthalmol 2014; 62:731-3. [PMID: 25005207 PMCID: PMC4131332 DOI: 10.4103/0301-4738.136247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vitrectomy and endoresection is an alternative to enucleation for the treatment of large malignant choroidal melanoma. We report a rare case of extensive recurrence of choroidal malignant melanoma with extraocular extension 11 years after surgical endoresection without adjuvant treatment.
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Affiliation(s)
| | | | - Khalil Ghasemi Falavarjani
- Ophthalmologist, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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26
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Hassan SB, Sørensen JF, Olsen BN, Pedersen AE. Anti-CD40-mediated cancer immunotherapy: an update of recent and ongoing clinical trials. Immunopharmacol Immunotoxicol 2014; 36:96-104. [PMID: 24555495 DOI: 10.3109/08923973.2014.890626] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The costimulatory molecule CD40 is a member of the tumor necrosis factor (TNF) receptor superfamily and is expressed on various antigen presenting cells (APCs) as well as some tumor cells. The binding to the natural ligand CD40L, which is expressed on T helper cells, leads to APC activation and thus enhancement of immune responses. Treatment with anti-CD40 monoclonal antibodies has been exploited in several cancer immunotherapy studies in mice and led to the development of anti-CD40 antibodies for clinical use. Here, Dacetuzumab and Lucatumumab are in the most advanced stage and are being tested as treatment for malignancies such as chronic lymphatic leukemia (CLL), Multiple Myeloma (MM), and non-Hodgkin's lymphoma (NHL). The promising results from these early clinical trials have encouraged clinical drug development in order to investigate the effect of CD40 mAbs in combination with other cancer immunotherapies, in particular interleukin (IL)-2. An in-depth analysis of this immunotherapy is provided elsewhere. In the present review, we provide an update of the most recent clinical trials with anti-CD40 antibodies. We present and discuss recent and ongoing clinical trials in this field, including clinical studies which combine anti-CD40 treatment with other cancer-treatments, such as Rituximab and Tremelimumab.
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Affiliation(s)
- Sufia Butt Hassan
- Department of International Health, Immunology and Microbiology, University of Copenhagen , Copenhagen N , Denmark
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28
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Abstract
A 52-year-old gentleman presented with 1-week history of severe right-sided headache associated with reduced vision in his right, amblyopic eye. Examination revealed raised intraocular pressure at 64 mm Hg. The anterior chamber (AC) was shallow and there was a dense cataract with no red reflex or fundal view. The contralateral eye had a deep anterior chamber with normal pressure and a clear lens. He was treated initially for acute angle closure glaucoma. The anterior chamber remained shallow and the intraocular pressure uncontrolled, despite maximum medical therapy. Owing to the absent fundal view and unilateral AC shallowing, further imaging was performed and a choroidal mass was found to be responsible for anterior displacement of the lens and shallowing of the angle. He went on to have an enucleation of the right eye, and histological examination confirmed the diagnosis of choroidal melanoma.
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Affiliation(s)
- Shi Zhuan Tan
- Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK.
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29
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Molecular Genetics of Choroidal Melanoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Muller K, Naus N, Nowak PJ, Schmitz PI, de Pan C, van Santen CA, Marijnissen JP, Paridaens DA, Levendag PC, Luyten GP. Fractionated stereotactic radiotherapy for uveal melanoma, late clinical results. Radiother Oncol 2012; 102:219-24. [DOI: 10.1016/j.radonc.2011.06.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 04/16/2011] [Accepted: 06/24/2011] [Indexed: 12/17/2022]
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Ma J, Usui Y, Kezuka T, Okunuki Y, Zhang L, An X, Mizota A, Goto H. Costimulatory molecule expression on human uveal melanoma cells: functional analysis of CD40 and B7-H1. Exp Eye Res 2011; 96:98-106. [PMID: 22200489 DOI: 10.1016/j.exer.2011.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/04/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
Abstract
Costimulatory molecules play important roles in regulating T cell function in tumor immunity. In this study, we investigated costimulatory molecule expression on human uveal melanoma cells (a primary culture, and OCM-1, OMM-1 and 92-1 cell lines) and assessed the functional roles of selected costimulatory molecules. Uveal melanoma cells were incubated in the presence or absence of IFN-γ and expression of costimulatory molecules on the cells was measured by flow cytometry. The costimulatory effect of B7-H1-expressing uveal melanoma cells on cytokine production by purified T cells was studied in uveal melanoma/T cell co-culture experiments using a blocking anti-B7-H1 monoclonal antibody (mAb). The functional role of CD40-mediated interactions in modifying immune responses to uveal melanoma cells was assessed in vitro using recombinant human CD40 ligand (rhCD40L). MHC class I and B7-H1 were consistently detected and further upregulated by IFN-γ stimulation in all human uveal melanoma cell cultures. CD40 was consistently detected and further upregulated by IFN-γ stimulation in primary culture, OCM-1, and OMM-1 but not 92-1. IL-2 production from purified CD3(+) T cells co-stimulated with IFN-γ-treated uveal melanoma cells was significantly enhanced by the addition of anti-B7-H1 mAb. Treatment of primary culture, OCM-1, or OMM-1 with rhCD40L induced or enhanced secretion of chemokines IL-8, MCP-1, IP-10 and RANTES. These results suggest that the expression of B7-H1 on IFN-γ-treated uveal melanoma cells contributes to suppression of T cells by decreasing IL-2 production. In contrast, CD40 expressed on uveal melanoma cells plays an important role in augmenting anti-tumor immunity by stimulating chemokine production. The dual effects of CD40 and B7-H1 may contribute to positive or negative regulation of anti-tumor immune responses to human uveal melanoma.
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Affiliation(s)
- Juan Ma
- Department of Ophthalmology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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de A Silva DO, Matis GK, Costa LF, Kitamura MAP, de C Júnior EV, Barbosa BJAP, Santiago IB, Silva TI, de P A Silva FQ, Pereira CU, Azevedo Filho HRC. Ocular melanoma: Keep your eyes open for late brain metastases. Surg Neurol Int 2011; 2:144. [PMID: 22059139 PMCID: PMC3205508 DOI: 10.4103/2152-7806.85985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 09/13/2011] [Indexed: 12/05/2022] Open
Abstract
Background: The most frequent intraocular malignant tumor is choroidal melanoma (CM). Although brain metastasis is a common feature of other types of cancers, metastasis of CM to the brain is a rare entity. Case Description: The authors report a case of a 28-year-old woman presenting with a single brain metastasis, 10 years after the treatment of a CM. She underwent a total en-bloc resection of the lesion, and the diagnosis was confirmed histopathologically. The patient concomitantly received whole-brain irradiation therapy combined with chemotherapy, with a survival period of 24 months. Conclusion: The present case report draws attention to the necessity of a close and lifelong follow-up of patients treated for this malignancy. The international literature is also reviewed.
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[Muscle metastasis of a coroid melanoma]. ACTA ACUST UNITED AC 2011; 7:77-8. [PMID: 21794785 DOI: 10.1016/j.reuma.2009.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/14/2009] [Accepted: 10/17/2009] [Indexed: 11/21/2022]
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Martínez-Girón R. Spindle shaped pigmented cells in a vitreous fluid cytology. Diagn Cytopathol 2011; 39:194-5. [PMID: 21319321 DOI: 10.1002/dc.21360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zhou Y, Song X, Jia R, Wang H, Dai L, Xu X, Gu P, Ge S, Fan X. Radiation-inducible human tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) gene therapy: a novel treatment for radioresistant uveal melanoma. Pigment Cell Melanoma Res 2010; 23:661-74. [PMID: 20546535 DOI: 10.1111/j.1755-148x.2010.00729.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Uveal melanoma (UM) is one of the most therapy-resistant cancers. Radiotherapy is the preferred treatment for most cases of UM. However, some UM cells, such as the SP6.5 or OM431 cell lines, are relatively radioresistant. In this study, we attempted to improve the current UM therapy using an adenovirus radio-inducible gene therapy system. The antitumor adenovirus was constructed by inclusion of the radiation-inducible early growth response gene 1 (EGR1) promoter and the anticancer tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) gene. We demonstrated that the UM SP6.5 and OM431 cell lines were susceptible to the TRAIL-induced antitumor effect. TRAIL expression was enhanced in the adenovirus containing EGR1/TRAIL (Ad-ET) treatment group by radiotherapy, whereas Ad-ET significantly increased cell death and apoptosis caused by radiotherapy. In mice bearing xenograft tumors, apoptotic cells were detected in pathological tumor sections. Adenovirus Ad-ET combined with radiation therapy significantly inhibited tumor growth compared with the other treatment groups (P < 0.01). Our findings indicate that radioresponsive gene therapy has the potential to be a more effective and specific therapy for UM because the therapeutic gene can be spatially or temporally controlled by exogenous radiation.
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Affiliation(s)
- Yixiong Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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King K, Pigott DC, Edwards AR. Intraocular mass causing acute angle-closure glaucoma. Am J Emerg Med 2010; 28:644.e5-6. [DOI: 10.1016/j.ajem.2009.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/11/2009] [Indexed: 10/19/2022] Open
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Querques G, Bux AV, Iaculli C, Delle Noci N. Local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma. Eur J Ophthalmol 2009; 20:194-200. [PMID: 19882527 DOI: 10.1177/112067211002000127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the outcome of local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma. METHODS We retrospectively analyzed the records of 60 patients (60 eyes) managed by local resection (group 1, 30 patients, external or internal local resection) or combined local resection and plaque radiotherapy (group 2, 30 patients, both Ruthenium-106 or Cobalt-60), among the 364 melanomas treated at our Department of Ophthalmology, between January 1980 and December 2006. Main outcomes measures were postsurgical complications, visual acuity, local recurrence, reasons for enucleation, and development of metastasis. RESULTS The 2 groups of patients were considered sufficiently homogeneous as regards location, cell type, and age. Mean follow-up was 7 years. The median largest basal tumor diameter was 9.8 mm and 10.1, and the median tumor thickness was 7.9 mm and 8, respectively, in groups 1 and 2. No statistically significant differences resulted between group 1 and group 2 as regards postsurgical complications (vitreous hemorrhage, retinal detachment, maculopathy, cataract, and optic neuropathy) (p>0.05), visual acuity (p>0.05), local recurrence (p>0.05), reasons for enucleation (p>0.05), or development of metastasis (p>0.05). CONCLUSIONS No adjunctive benefits from the combined local resection and plaque radiotherapy can be ruled out from our study.
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Affiliation(s)
- Giuseppe Querques
- Department of Ophthalmology, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy.
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Schaaf H, Streckbein P, Schmidt S, Howaldt HP, Gräf M. Palliative surgery for contralateral metastasis of orbital melanoma to prevent blindness. Clin Exp Ophthalmol 2008; 36:483-4. [PMID: 18925919 DOI: 10.1111/j.1442-9071.2008.001775.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kearns C, Boyer S, Gay D. Two differing presentations, treatments, and outcomes of malignant choroidal melanoma. ACTA ACUST UNITED AC 2008; 79:365-70. [PMID: 18577493 DOI: 10.1016/j.optm.2007.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/11/2007] [Accepted: 10/29/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Choroidal melanomas represent the most common primary malignancy of the eye. As primary eye care providers, optometrists must be able to identify suspicious lesions to facilitate proper referrals and timely treatment. Metastasis occurs in approximately 75% of cases. Ongoing studies such as the Collaborative Ocular Melanoma Study are bringing new information on how to best manage choroidal melanoma. Current treatments include enucleation, plaque brachytherapy, and transpupillary thermotherapy. CASE REPORT Two patients presented to the Veterans Affairs (VA) Illiana Health Care System optometry clinic for routine visits and had malignant melanomas diagnosed. The first patient was in for a 6-month routine glaucoma follow-up, noting that the right eye seemed to be worse. The second patient was new, complaining of a painful, red eye. Both were referred to a retinal specialist and later treated by an ocular oncologist with enucleation and plaque brachytherapy, respectively. Their differing chief complaints and cases are discussed. CONCLUSION Patients with malignant choroidal melanomas present with a wide variety of complaints, and optometrists need to be diligent in properly assessing the cause of seemingly common conditions, such as anterior uveitis, as well as performing routine dilated fundus examinations. Given the relationship between size and prognosis, early detection is important.
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Affiliation(s)
- Carrie Kearns
- Department of Veterans Affairs, Illiana Healthcare System, Danville, IL, USA.
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Belmar-Lopez C, Mancheno-Corvo P, Saornil MA, Baril P, Vassaux G, Quintanilla M, Martin-Duque P. Uveal vs. cutaneous melanoma. Origins and causes of the differences. Clin Transl Oncol 2008; 10:137-42. [PMID: 18321815 DOI: 10.1007/s12094-008-0170-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Melanoma is a malignant tumour derived from melanocytes (dendritic cells originated from the neural crest and capable to produce melanin synthesis) that could be established on the skin or less frequently on the uvea. The cellular origin from both kind of melanoma seems to be the same but the melanocytes migrates to the epithelia for cutaneous melanoma, while for uveal melanoma, they migrate to mesodermic tissues. Despite the common origin, both melanomas show extreme differences in their metastatic potential, clinical response to treatments, immune response and genetic alterations. We will describe some of those differences in this review.
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Affiliation(s)
- Carolina Belmar-Lopez
- Universidad Francisco de Vitoria, Facultad de Ciencias Biosanitarias, Dpto. Biotecnología, Pozuelo de Alarcón, Madrid, Spain
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Odell KR. Review of the poster "Dosimetric comparison of gamma knife radiosurgery vs. 125I plaque brachytherapy in a cohort of choroidal melanomas". Med Dosim 2008; 34:107-9. [PMID: 19410138 DOI: 10.1016/j.meddos.2008.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/05/2008] [Accepted: 05/14/2008] [Indexed: 11/26/2022]
Abstract
Historically, treatment for choroidal melanomas was surgical enucleation. Currently, treatment methods such as stereotactic radiosurgery and brachytherapy are being used to spare the eye. The poster "Dosimetric Comparison of Gamma Knife Radiosurgery vs. I-125 Plaque Brachytherapy in a Cohort of Choroidal Melanomas" presented at ASTRO 2007 by Anderson et al. provides a comparison of these methods. The dose to disk, fovea and lens in 29 patients from a simulated I-125 treatment and a delivered Gamma Knife radiosurgery was compared. Thirty Gy was prescribed to the 50% Isodose line in the radiosurgery and 85 Gy was prescribed to the apex of the tumor in the I-125 simulation. It was found that the Gamma Knife spares the disk better in 59% of the tumors, including those >or=6.5 mm in height; spares the fovea better in 69% of the tumors, including those >or=5.5 mm; and spares lens better in only 30% of the tumors, with no distinction in size. Tumor location was not taken into account for this study, which could explain the variations in smaller tumors. For larger tumors, gamma knife will protect most organs at risk more effectively. This study shows how a tumor's parameters can be used in selecting treatment modality.
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Affiliation(s)
- Kelly R Odell
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Cools-Lartigue J, Marshall JC, Faingold D, Burnier Jr MN. A view of VEGF in ocular melanoma: prospective implications for patient care. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Esquivel C, Fuller CD, Waggener RG, Wong A, Meltz M, Blough M, Eng TY, Thomas CR. Novel low-kVp beamlet system for choroidal melanoma. Radiat Oncol 2006; 1:36. [PMID: 16965624 PMCID: PMC1586203 DOI: 10.1186/1748-717x-1-36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 09/11/2006] [Indexed: 12/04/2022] Open
Abstract
Background Treatment of choroidal melanoma with radiation often involves placement of customized brachytherapy eye-plaques. However, the dosimetric properties inherent in source-based radiotherapy preclude facile dose optimization to critical ocular structures. Consequently, we have constructed a novel system for utilizing small beam low-energy radiation delivery, the Beamlet Low-kVp X-ray, or "BLOKX" system. This technique relies on an isocentric rotational approach to deliver dose to target volumes within the eye, while potentially sparing normal structures. Methods Monte Carlo N-Particle (MCNP) transport code version 5.0(14) was used to simulate photon interaction with normal and tumor tissues within modeled right eye phantoms. Five modeled dome-shaped tumors with a diameter and apical height of 8 mm and 6 mm, respectively, were simulated distinct positions with respect to the macula iteratively. A single fixed 9 × 9 mm2 beamlet, and a comparison COMS protocol plaque containing eight I-125 seeds (apparent activity of 8 mCi) placed on the scleral surface of the eye adjacent to the tumor, were utilized to determine dosimetric parameters at tumor and adjacent tissues. After MCNP simulation, comparison of dose distribution at each of the 5 tumor positions for each modality (BLOKX vs. eye-plaque) was performed. Results Tumor-base doses ranged from 87.1–102.8 Gy for the BLOKX procedure, and from 335.3–338.6 Gy for the eye-plaque procedure. A reduction of dose of at least 69% to tumor base was noted when using the BLOKX. The BLOKX technique showed a significant reduction of dose, 89.8%, to the macula compared to the episcleral plaque. A minimum 71.0 % decrease in dose to the optic nerve occurred when the BLOKX was used. Conclusion The BLOKX technique allows more favorable dose distribution in comparison to standard COMS brachytherapy, as simulated using a Monte Carlo iterative mathematical modeling. Future series to determine clinical utility of such an approach are warranted.
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Affiliation(s)
- Carlos Esquivel
- Cancer Therapy and Research Center, San Antonio, TX, USA
- Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Clifton D Fuller
- Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert G Waggener
- Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Adrian Wong
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science at Houston, Houston, TX, USA
| | - Martin Meltz
- Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Melissa Blough
- Cancer Therapy and Research Center, San Antonio, TX, USA
- Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Tony Y Eng
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA
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Chong GT, Kim RJ, Ambati SR, Wong TZ, Dibernardo LR, Merkle EM, Ryan T, Morse MA. Diagnosis of a solitary cardiac metastasis from ocular melanoma. J Thorac Cardiovasc Surg 2005; 130:1727-8. [PMID: 16308029 DOI: 10.1016/j.jtcvs.2005.07.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 07/26/2005] [Indexed: 10/25/2022]
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