Treatment of Metastatic Uveal (Ocular) Melanoma
Jefferson is a nationwide referral center for patients with uveal melanoma, the most common malignant tumor originating in the eye. At the time of diagnosis, more than 95% of patients have tumors limited to the eye, but at least 30% of these patients will subsequently develop metastases to other parts of the body, most commonly the liver and often several years after the diagnosis of the primary tumor. The clinical course of patients with uveal melanoma is generally determined by progression of the disease in the liver. Historically, median survival of patients with metastatic uveal melanoma to the liver has been up to 5 months. There are currently no effective systemic chemotherapy regimens for treatment of liver metastases from this tumor.
In patients who are not candidates for surgical treatment of liver metastases due to either multiple tumors or additional tumors outside of the liver, we offer several treatment regimens, in close collaboration with Takami Sato, M.D., Ph.D., a medical oncologist specializing in the treatment of metastatic uveal melanoma.
IMMUNOEMBOLIZATION was developed at Jefferson as a novel therapy to improve survival in uveal melanoma patients with liver metastases. In this approach, cytokines (drugs which stimulate or modulate immune responses) are injected directly into the arteries supplying the liver in attempts to induce an inflammatory response in the tumor to eliminate tumor cells. The cytokine injection is combined with embolization of the hepatic artery. Embolization involves blocking off the blood supply to the tumors by injecting an oily liquid (Ethiodol) and a temporary dissolvable agent (Gelfoam) into the arteries supplying the liver which helps to kill the tumors. This also presents tumor antigens to the immune system. Local stimulation of the immune system may result in development of a systemic immune response against tumor cells which could suppress the growth of additional tumors outside of the liver.
CHEMOEMBOLIZATION is performed for patients with more extensive tumor involvement in the liver. BCNU (a chemotherapy drug) dissolved in an oily liquid (Ethiodol) is injected directly into the arteries supplying the liver, along with a temporary dissolvable agent (Gelfoam) to block off the blood supply to the tumors.
RADIOEMBOLIZATION (administration of Yttrium-90 radioactive microspheres) is also being investigated in the treatment of uveal melanoma metastases to the liver. Tiny beads with an embedded radioactive material are injected directly into the arteries supplying the liver to kill the tumors. We are initiating a clinical trial to further study the effectiveness of this procedure for these tumors.
Our division performs more than 300 liver embolization procedures/year for patients with metastatic uveal melanoma. We have treated a number of patients with this disease using radioactive microspheres.
Case Study, Metastatic Uveal Melanoma
Case Study, Immunoembolization of Metastatic Uveal Melanoma
Case Study, Liver Ablation of Metastatic Uveal Melanoma:
Case Study, Ablation of a Solitary Lung Metastasis from Uveal Melanoma:
Case Study: Vertebroplasty of a Painful Skeletal Metastasis from Uveal Melanoma:
To schedule an examination call (215) 955-6440.
Immunoembolization of malignant liver tumors, including uveal melanoma, using granulocyte-macrophage colony-stimulating factor. Journal of Clinical Oncology 2008; 26:5436-5442
Prognostic factors for survival after embolization of hepatic metastases in patients with uveal melanoma. Radiology 2009 (in press)
Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: Results of a phase II study. Melanoma Research 2005; 15:297-304
Treatment of uveal melanoma liver metastases using Y-90 SIR-spheres: Imaging and clinical response. JVIR 2008; 19:S50.
Current Cliincal Trial:
Immunoembolization of hepatic artery with granulocyte-macrophage colony stimulating factor (GM-CSF): NIH 1 R21 CA103250-01 A2.