David Lawson, MD, from Winship Cancer Institute of Emory University presents Prognosis and Medical Oncology Follow-up of Uveal Melanoma at the 2016 CURE OM Patient & Caregiver Symposium

1. Prognosis and Medical Oncology
Followup of Uveal Melanoma
Eyes on a Cure
Patient and Caregiver Symposium
MRF/CURE Ocular Melanoma

2. Prognosis of Treated Primary Uveal
Melanoma
• Decide for yourself how much you want to
know
• “Uncertainty is in fact truth” Shah JAMA 2016
• Can be
– Anatomically based (TNM)
– Based on chromosomal changes (3p deletion)
– Based on gene expression profile (Castle
Biosciences)
– BAP-1 mutations don’t supersede these

3. Further Progression in Genetic
Predictors
• EIF1AX and SF3B1 mutations may be
associated with better prognosis in the Class
1, favorable, group
• BAP-1 mutations are associated with poor
prognosis

4. Prognosis
• The anatomic method (TNM) does not require
biopsy
• The gene expression profiling is more
accurate, at least in one study
• Likely further refinement possible from
combining them

5. Surveillance
• There is not general agreement about how
best to do this
• This is largely because of lack of definitive
data
• Trials, including a possible registry, are
essential

6. Goals of Surveillance
• Live longer
• Live better

7. Options
• History and Physical Exam
• Labs, especially liver enzymes
• Ultrasound
• CT
• PET
• MRI

8. History and Physical
• Not invasive, safe
• Not very sensitive

9. Liver enzymes
• Minimally invasive
• Not very sensitive

10. Ultrasound
• No pain, no risk (they do it to fetuses)
• More sensitive than exam and labs
• Operator dependent
• Not uncommonly need followup CR or MRI

11. CT
• More sensitive than US
• Need for contrast: possible allergic reactions,
kidney damage
• Radiation exposure
• Time and expense

12. PET/CT
• Expensive.
• Still have radiation exposure
• Sensitive but not as specific; more likely to
have false positives

13. MRI
• Probably the best imaging for the liver
• Expensive
• Some issues with contast, but uncommon

14. Individualize
• Good prognosis probably no need for scans
• Poor prognosis usually every 3 months for
exam.
• Some combination of scans, also usually every
3 months. Mostly US and MRI
• Duration: first 3 years or so, then extend

15. Adjuvant Therapy
• No standard treatment
• Participation in clinical trials strongly
encouraged
• Sunitinib vs Valproic Acid Thomas Jefferson
high risk as defined by GEP or monosomy 3
and 8q amplification
• Crizotinib single arm Memorial Sloan Kettering
high risk as defined by GEP

16. Going Forward
• Thank you for your support of melanoma
research
• This is a rare disease. Stick together.
• Consider forming a registry