Uveal melanoma

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Ryan Nguyen, DO
University of Illinois at Chicago
Chicago, IL

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Elizabeth Buchbinder, MD
Dana-Farber Cancer Institute
Boston, MA

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Note: this page is for regimens specific to uveal melanoma; see the main melanoma page for other regimens.

10 regimens on this page
11 variants on this page


Guidelines

NCCN

Metastatic or unresectable disease

Dacarbazine monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Carvajal et al. 2014 (MSK 10-053) 2010-2013 Randomized Phase 2 (C) Selumetinib Might have inferior OS
Carvajal et al. 2018 (SUMIT) 2014-2015 Phase 3 (C) Dacarbazine & Selumetinib Did not meet primary endpoint of PFS
Nathan et al. 2021 (IMCgp100-202) 2017-2020 Phase 3 (C) Tebentafusp Inferior OS

Chemotherapy

21-day cycles

References

  1. MSK 10-053: Carvajal RD, Sosman JA, Quevedo JF, Milhem MM, Joshua AM, Kudchadkar RR, Linette GP, Gajewski TF, Lutzky J, Lawson DH, Lao CD, Flynn PJ, Albertini MR, Sato T, Lewis K, Doyle A, Ancell K, Panageas KS, Bluth M, Hedvat C, Erinjeri J, Ambrosini G, Marr B, Abramson DH, Dickson MA, Wolchok JD, Chapman PB, Schwartz GK. Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial. JAMA. 2014 Jun 18;311(23):2397-405. link to original article link to PMC article PubMed NCT01143402
  2. SUMIT: Carvajal RD, Piperno-Neumann S, Kapiteijn E, Chapman PB, Frank S, Joshua AM, Piulats JM, Wolter P, Cocquyt V, Chmielowski B, Evans TRJ, Gastaud L, Linette G, Berking C, Schachter J, Rodrigues MJ, Shoushtari AN, Clemett D, Ghiorghiu D, Mariani G, Spratt S, Lovick S, Barker P, Kilgour E, Lai Z, Schwartz GK, Nathan P. Selumetinib in combination with dacarbazine in patients with metastatic uveal melanoma: a phase III, multicenter, randomized trial (SUMIT). J Clin Oncol. 2018 Apr 20;36(12):1232-1239. Epub 2018 Mar 12. link to original article contains verified protocol PubMed NCT01974752
  3. IMCgp100-202: Nathan P, Hassel JC, Rutkowski P, Baurain JF, Butler MO, Schlaak M, Sullivan RJ, Ochsenreither S, Dummer R, Kirkwood JM, Joshua AM, Sacco JJ, Shoushtari AN, Orloff M, Piulats JM, Milhem M, Salama AKS, Curti B, Demidov L, Gastaud L, Mauch C, Yushak M, Carvajal RD, Hamid O, Abdullah SE, Holland C, Goodall H, Piperno-Neumann S; IMCgp100-202 Investigators. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med. 2021 Sep 23;385(13):1196-1206. link to original article contains verified protocol PubMed NCT03070392

Fotemustine monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Leyvraz et al. 2014 (EORTC 18021) 2005-2011 Phase 3 (C) Fotemustine; HAI Did not meet primary endpoint of OS

Chemotherapy

  • Fotemustine (Muphoran) as follows:
    • Weeks 1 to 3: 100 mg/m2 IV once per day on days 1, 8, 15
    • Weeks 4 to 8: no treatment
    • Week 9 onwards: 100 mg/m2 IV once on day 1, every 3 weeks

8-week induction cycle, then 21-day cycles

References

  1. EORTC 18021: Leyvraz S, Piperno-Neumann S, Suciu S, Baurain JF, Zdzienicki M, Testori A, Marshall E, Scheulen M, Jouary T, Negrier S, Vermorken JB, Kaempgen E, Durando X, Schadendorf D, Karra Gurunath R, Keilholz U. Hepatic intra-arterial versus intravenous fotemustine in patients with liver metastases from uveal melanoma (EORTC 18021): a multicentric randomized trial. Ann Oncol. 2014 Mar;25(3):742-6. Epub 2014 Feb 7. link to original article link to PMC article contains protocol PubMed NCT00110123

Ipilimumab monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Nathan et al. 2021 (IMCgp100-202) 2017-2020 Phase 3 (C) Tebentafusp Inferior OS

Immunotherapy

21-day cycle for up to 4 cycles

References

  1. IMCgp100-202: Nathan P, Hassel JC, Rutkowski P, Baurain JF, Butler MO, Schlaak M, Sullivan RJ, Ochsenreither S, Dummer R, Kirkwood JM, Joshua AM, Sacco JJ, Shoushtari AN, Orloff M, Piulats JM, Milhem M, Salama AKS, Curti B, Demidov L, Gastaud L, Mauch C, Yushak M, Carvajal RD, Hamid O, Abdullah SE, Holland C, Goodall H, Piperno-Neumann S; IMCgp100-202 Investigators. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med. 2021 Sep 23;385(13):1196-1206. link to original article contains verified protocol PubMed NCT03070392

Ipilimumab & Nivolumab

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Regimen variant #1, "NIVO1+IPI3", flat-dose maintenance

Study Evidence
Piulats et al. 2021 (GEM-1402) Phase 2

Immunotherapy

21-day cycle for 4 cycles, then 14-day cycles

Regimen variant #2, "NIVO3+IPI1", flat-dose maintenance

Study Evidence
Pelster et al. 2020 (MDACC 2011-0919) Phase 2

Immunotherapy

21-day cycle for 4 cycles, then 28-day cycles

References

  1. GEM-1402: Piulats JM, Espinosa E, de la Cruz Merino L, Varela M, Alonso Carrión L, Martín-Algarra S, López Castro R, Curiel T, Rodríguez-Abreu D, Redrado M, Gomà M, Rullán AJ, Calvo González A, Berrocal-Jaime A. Nivolumab Plus Ipilimumab for Treatment-Naïve Metastatic Uveal Melanoma: An Open-Label, Multicenter, Phase II Trial by the Spanish Multidisciplinary Melanoma Group (GEM-1402). J Clin Oncol. 2021 Feb 20;39(6):586-598. link to original article PubMed NCT02626962
  2. MDACC 2011-0919: Pelster MS, Gruschkus SK, Bassett R, Gombos DS, Shephard M, Posada L, Glover MS, Simien R, Diab A, Hwu P, Carter BW, Patel SP. Nivolumab and Ipilimumab in Metastatic Uveal Melanoma: Results From a Single-Arm Phase II Study. J Clin Oncol. 2021 Feb 20;39(6):599-607. Epub 2020 Oct 30. link to original article PubMed NCT01585194

Pembrolizumab monotherapy

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Regimen variant #1, weight-based

Study Years of enrollment Evidence Comparator Comparative Efficacy
Nathan et al. 2021 (IMCgp100-202) 2017-2020 Phase 3 (C) Tebentafusp Inferior OS

Immunotherapy

21-day cycles

Regimen variant #2, flat dosing

Study Years of enrollment Evidence Comparator Comparative Efficacy
Nathan et al. 2021 (IMCgp100-202) 2017-2020 Phase 3 (C) Tebentafusp Inferior OS

Immunotherapy

21-day cycles

References

  1. IMCgp100-202: Nathan P, Hassel JC, Rutkowski P, Baurain JF, Butler MO, Schlaak M, Sullivan RJ, Ochsenreither S, Dummer R, Kirkwood JM, Joshua AM, Sacco JJ, Shoushtari AN, Orloff M, Piulats JM, Milhem M, Salama AKS, Curti B, Demidov L, Gastaud L, Mauch C, Yushak M, Carvajal RD, Hamid O, Abdullah SE, Holland C, Goodall H, Piperno-Neumann S; IMCgp100-202 Investigators. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med. 2021 Sep 23;385(13):1196-1206. link to original article contains verified protocol PubMed NCT03070392

TACE monotherapy

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TACE: Trans-Arterial Chemo-Embolization

Regimen

Study Evidence
Mavligit et al. 1988 Non-randomized

Chemotherapy

1 or more treatments

References

  1. Mavligit GM, Charnsangavej C, Carrasco CH, Patt YZ, Benjamin RS, Wallace S. Regression of ocular melanoma metastatic to the liver after hepatic arterial chemoembolization with cisplatin and polyvinyl sponge. JAMA. 1988 Aug 19;260(7):974-6. link to original article PubMed

Selumetinib monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Carvajal et al. 2014 (MSK 10-053) 2010-2013 Randomized Phase 2 (E-switch-ooc) 1. Dacarbazine
2. Temozolomide
Might have superior OS

Targeted therapy

Continued indefinitely

References

  1. MSK 10-053: Carvajal RD, Sosman JA, Quevedo JF, Milhem MM, Joshua AM, Kudchadkar RR, Linette GP, Gajewski TF, Lutzky J, Lawson DH, Lao CD, Flynn PJ, Albertini MR, Sato T, Lewis K, Doyle A, Ancell K, Panageas KS, Bluth M, Hedvat C, Erinjeri J, Ambrosini G, Marr B, Abramson DH, Dickson MA, Wolchok JD, Chapman PB, Schwartz GK. Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial. JAMA. 2014 Jun 18;311(23):2397-405. link to original article link to PMC article contains verified protocol PubMed NCT01143402

Tebentafusp monotherapy

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Regimen

FDA-recommended dose
Study Years of enrollment Evidence Comparator Comparative Efficacy
Nathan et al. 2021 (IMCgp100-202) 2017-2020 Phase 3 (E-RT-switch-ooc) Investigator's choice of:
1. Dacarbazine
2. Ipilimumab
3. Pembrolizumab
Superior OS
OS12: 73% vs 59%
(HR 0.51, 95% CI 0.37-0.71)

Immunotherapy

  • Tebentafusp (Kimmtrak) as follows:
    • Cycle 1: 20 mcg IV once on day 1
    • Cycle 2: 30 mcg IV once on day 1
    • Cycle 3 onwards: 68 mcg IV once on day 1

7-day cycles

References

  1. IMCgp100-202: Nathan P, Hassel JC, Rutkowski P, Baurain JF, Butler MO, Schlaak M, Sullivan RJ, Ochsenreither S, Dummer R, Kirkwood JM, Joshua AM, Sacco JJ, Shoushtari AN, Orloff M, Piulats JM, Milhem M, Salama AKS, Curti B, Demidov L, Gastaud L, Mauch C, Yushak M, Carvajal RD, Hamid O, Abdullah SE, Holland C, Goodall H, Piperno-Neumann S; IMCgp100-202 Investigators. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. N Engl J Med. 2021 Sep 23;385(13):1196-1206. link to original article contains verified protocol PubMed NCT03070392

Temozolomide monotherapy

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Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Carvajal et al. 2014 (MSK 10-053) 2010-2013 Randomized Phase 2 (C) Selumetinib Might have inferior OS

Chemotherapy

28-day cycles

References

  1. MSK 10-053: Carvajal RD, Sosman JA, Quevedo JF, Milhem MM, Joshua AM, Kudchadkar RR, Linette GP, Gajewski TF, Lutzky J, Lawson DH, Lao CD, Flynn PJ, Albertini MR, Sato T, Lewis K, Doyle A, Ancell K, Panageas KS, Bluth M, Hedvat C, Erinjeri J, Ambrosini G, Marr B, Abramson DH, Dickson MA, Wolchok JD, Chapman PB, Schwartz GK. Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial. JAMA. 2014 Jun 18;311(23):2397-405. link to original article link to PMC article contains protocol PubMed NCT01143402

TILs

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TILs: Tumor Ifiltrating Lymphocytes

Regimen

Study Evidence
Chandran et al. 2017 (NCI 13-C-0093) Phase 2

Preceding treatment

  • FC lymphodepletion

Immunotherapy

References

  1. NCI 13-C-0093: Chandran SS, Somerville RPT, Yang JC, Sherry RM, Klebanoff CA, Goff SL, Wunderlich JR, Danforth DN, Zlott D, Paria BC, Sabesan AC, Srivastava AK, Xi L, Pham TH, Raffeld M, White DE, Toomey MA, Rosenberg SA, Kammula US. Treatment of metastatic uveal melanoma with adoptive transfer of tumour-infiltrating lymphocytes: a single-centre, two-stage, single-arm, phase 2 study. Lancet Oncol. 2017 Jun;18(6):792-802. Epub 2017 Apr 7. link to original article link to PMC article PubMed NCT01814046