Prognostic Hematologic Biomarkers Following Immune Checkpoint Inhibition in Metastatic Uveal Melanoma

The Future of Checkpoint Inhibitors in Uveal Melanoma: A Narrative Review

INTRODUCTION

Immune checkpoint inhibitors have made tremendous progress over the last decade in the treatment of cutaneous melanoma, but their application in uveal melanoma treatment is less successful, owing in part to the immunological privilege of the eye and the liver, the most frequent site of metastasis. Nevertheless, the therapeutic outcomes reported currently are less pessimistic.

METHODS

In this review, we provide an overview of recent studies of immune checkpoint inhibitors in uveal melanoma and its metastasis and classify studies in this field into three groups: monotherapy of immune checkpoint inhibitors, dual-agent immune checkpoint inhibitors, and immune checkpoint inhibitors combined with other systemic or regional therapies.

RESULTS

Briefly, monotherapy with immune checkpoint inhibitors performed poorly. Dual-agent immune checkpoint inhibitors had slightly better outcomes than traditional treatments, especially in specific patient populations. As for the combination therapy, the combination with other systemic therapies did not show superiority over dual-agent immune checkpoint inhibitors, but combination with hepatic regional therapies was quite promising. Moreover, research on emerging checkpoints is currently limited to the stage of mechanistic studies.

CONCLUSION

We propose that immune checkpoint inhibitors remain alternative treatments for patients with uveal melanoma, but factors such as cost-effectiveness should also be taken into account. The combination therapy with immune checkpoint inhibitors deserves to be further explored.

Immunotherapy in melanoma: Can we predict response to treatment with circulating biomarkers?

Melanoma is the most aggressive form of skin cancer, representing approximately 4% of all cutaneous neoplasms and accounting for up to 80% of deaths. Advanced stages of melanoma involve metastatic processes and are associated with high mortality and morbidity, mainly due to the rapid dissemination and heterogeneous responses to current therapies, including immunotherapy. Immune checkpoint inhibitors (ICIs) are currently used in the treatment of metastatic melanoma (MM) and despite being linked to an increase in patient survival, a high percentage of them still do not benefit from it. Accordingly, the number of therapeutic regimens for MM patients using ICIs either alone or in combination with other therapies has increased, together with the need for reliable biomarkers that can both predict and monitor response to ICIs. In this context, circulating biomarkers, such as DNA, RNA, proteins, and cells, have emerged due to their ability to reflect disease status. Moreover, blood tests are minimally invasive and provide an attractive option to detect biomarkers, avoiding stressful medical procedures. This systematic review aims to evaluate the possibility of a non-invasive biomarker signature that can guide therapeutic decisions. The studies reported here offer valuable insight into how circulating biomarkers can have a role in personalized treatments for melanoma patients receiving ICIs therapy, emphasizing the need for rigorous clinical trials to confirm findings and establish standardized procedures.

Prognostic value of lactate dehydrogenase in patients with uveal melanoma treated with immune checkpoint inhibition

OBJECTIVE

We performed the meta-analysis to explore the predictive value of lactate dehydrogenase (LDH) levels in uveal melanoma (UM) patients receiving immune checkpoint inhibitors (ICIs).

METHODS

Eligible articles were obtained through EMBASE, PubMed, Google Scholar, and the Cochrane Library, until March 23, 2023. The clinical outcomes evaluated in this study encompassed overall survival (OS) and progression-free survival (PFS).

RESULTS

This meta-analysis comprised eight studies with a combined total of 383 patients. The results showed that patients with high LDH levels had noticeably worse OS (HR: 3.445, 95% CI: 2.504-4.740, p < 0.001) and PFS (HR: 1.720, 95% CI: 1.429-2.070, p < 0.001). Subgroup analysis confirmed that the upper limit of normal was the ideal cut-off value for LDH. In multivariate analysis, we also found that high LDH levels significantly predicted shorter OS (HR: 3.405, 95% CI: 1.827-6.348, p < 0.001) and PFS (HR: 2.519, 95% CI: 1.557-4.076, p < 0.001) in UM patients. The sensitivity analysis and publication bias test supported the reliability of our results.

CONCLUSIONS

In UM patients treated with ICIs, the LDH levels were reliable indicators of prognosis.