Uveal (Eye) Melanoma
Offering a highly advanced level of treatment for patients whose uveal melanoma has metastasized, Thomas Jefferson University Hospitals have become a national referral center for this rare cancer. In fact, two-thirds of patients come to the multidisciplinary Uveal Melanoma Center from outside of the tri-state area. About 100 new patients with metastatic uveal melanoma have been seen every year since 1999.
Takami Sato, MD, PhD*
*Practice Focus: Uveal Melanoma
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Thomas Jefferson University Hospital
Despite successful treatment of primary uveal melanoma, up to 50 percent will develop a systemic metastasis, and in 70 to 90 percent of those cases, the metastasis will be to the liver. There are currently no effective systemic chemotherapy regimens for treatment of metastasis of uveal melanoma to the liver, and only a few patients, usually with a single small metastasis that appeared five years or longer after treatment for primary uveal melanoma, are candidates for surgical treatment. Locoregional (liver-directed) therapies, however, appear to hold promise, based on research conducted at Jefferson. The treatment modalities offered are:
- Immunoembolization, which involves injecting cytokines (immunostimulants) directly into the arteries supplying the liver, combined with embolization of the hepatic artery.
- Transarterial chemoembolization (TACE), which consists of hepatic artery embolization with simultaneous infusion of concentrated chemotherapeutic drugs.
- Selective internal radiation therapy (SIRT), which delivers high-dose radiation to tumors while minimizing damage to surrounding normal tissue.
- Drug-eluting beads, which deliver a local, controlled, sustained dose of chemotherapeutic medications to the tumors.
Factors considered in deciding which treatment is appropriate are the length of time to systemic metastasis, whether there is a solitary tumor or multiple tumors and tumor volume (percentage of liver involvement). Very few centers in the country offer this wide range of treatments. In fact, none offers immunoembolization, which was developed at Jefferson and which has been shown to increase length of survival from five months at best to an average of 14.5 months or more – a statistically significant improvement – with modest toxicities. Approximately 400 liver-directed treatment procedures are performed annually for uveal melanoma patients with hepatic metastasis at Thomas Jefferson University Hospitals.