Multimodal Regimen Yields Remission in Liver Metastases from Uveal Melanoma

A retrospective study showed that an intensive surveillance program followed by aggressive multimodal treatment, including surgical resection and ablation, extended long-term remission for patients with liver metastasis from uveal melanoma (LMUM), according to findings published in Annals of Surgery Open.

Investigators conducted the analysis to evaluate how a standardized follow-up protocol and multidisciplinary surgical interventions impacted the prognosis of patients with hepatic-only or hepatic-dominant uveal melanoma between 2010 and 2024.

Main Data

Patients were divided into 2 groups. In group A, patients had multifocal disease and were not undergoing liver surgical/ablative treatment (n = 27). In group B, patients had oligometastatic liver disease and had liver resection/ablation (n = 31).

In patients treated for LMUM, median liver-specific overall survival (OS) was 18.6 months (95% CI, 13.8-23.8) in group A and 45.1 months (95% CI, 33.5-not reached) in group B (HR, 0.13; 95% CI, 0.06-0.28; P <.0001) The median OS from the treatment of primary uveal melanoma was 3.6 years (95% CI, 2.5-5.5) in group A and 14.1 years (95% CI, 8.2-20.8) in group B (HR, 0.24; 95% CI, 0.11-0.50; P <.0001).

As a primary modality, 21 patients with LMUM had liver resection, and 18 patients received an R0 resection, and in group B, 10 had liver ablation. Adjuvant immunotherapy was offered with intense surveying for 3 to 6 months after surgery.

The multivariable analysis for OS assessed group A vs B after LMUM (HR, 0.14; 95% CI, 0.04-0.45) and after uveal melanoma (HR, 0.21; 95% CI, 0.06-0.69); age at uveal melanoma diagnoses after LMUM (HR, 1.01; 95% CI, 0.99-1.05) and after uveal melanoma (HR, 1.02; 95% CI, 0.99-1.05); the interval between uveal melanoma and LMUM after LMUM (HR, 0.99; 95% CI, 0.99-1.00) and after uveal melanoma (HR, 0.99; 95% CI, 0.99-1.00); and unilobar/bilobar metastases after LMUM (HR, 0.67; 95% CI, 0.25-1.94) and after uveal melanoma (HR, 1.03; 95% CI, 0.37-3.05).

“[T]he data presented from London, UK, highlight an important role for loco-regional surgical/ablative therapy in LMUM, providing the best survival outcomes reported to date in this disease subset,” lead study author Hemant Kocher, MBBS, MS, MD, FRCS, a professor of Liver and Pancreas Surgery at Barts Cancer Institute, wrote with coauthors in the publication. “While case selection may be an important factor, our intensively managed surgical series of patients argues for further studies incorporating resection of oligometastatic disease and adjuvant immunotherapy in the treatment of LMUM.”

Trial Details

The study utilized a retrospective analysis in which patients were identified from the prospectively managed database from Barts Health National Health Service Trust. Research aimed to assess the efficacy of a dedicated multidisciplinary program designed specifically for the management of uveal melanoma.

The median age at the time of the primary diagnosis was 65 years old, a majority of patients were female, and 47 patients had an ECOG performance status of 0. The median age at primary uveal melanoma diagnosis was 59 years, and the median interval between uveal melanoma and LMUM was 2.7 years.

Patients who were eligible for treatment underwent diagnostic laparoscopy that explored the entire abdominal cavity with the liver. The liver was inspected through an intraoperative ultrasound and a biopsy. A liver mastectomy could be performed during this procedure, if feasible.

When patients were diagnosed and treated for uveal melanoma, they were followed up with a liver ultrasound and ophthalmic examination every 6 months. A CT scan or MRI was performed if metastases were suspected. A multidisciplinary team meeting was conducted if oligometastatic liver-only disease was suspected.

Reference

Kocher HM, Gani A, Belibagli ZO, et al. Intensive surveillance and aggressive multimodal treatment for liver metastases from uveal melanoma. Ann Surg Open. 2025;6(4):e620. doi:10.1097/AS9.0000000000000620