An international staging system and genetic data have allowed for a more exact assessment of the risk for metastases in primary intraocular uveal melanoma cases, and its treatment has advanced significantly in recent years. Distant metastases, which occurred in roughly half of the patients, remain a risk. Although metastatic disease was the major cause of death following a diagnosis of uveal melanoma, there is still no agreement on how to best monitor for and treat disseminated illness. Solving these problems to treat metastatic illness was the final frontier in the fight against uveal melanoma. Small, uncontrolled, retrospective studies that don’t disclose staging were the norm regarding metastatic uveal melanoma. The median overall survival after diagnosis was 10–13 months, and the cure rate was close to 0, according to meta-analyses; nonetheless, survival rates of over 5 years were feasible, estimated at 2% with 1st-line treatment or optimum supportive care. Current research suggested that hepatic ultrasonography and magnetic resonance imaging could be used for surveillance with a sensitivity of 95-100% and 83-100%, respectively, to detect metastases without radiation hazards, but that computed tomography was required for staging. However, there are currently no well-accepted blood tests beyond those for liver function. Overall survival following metastasis could be predicted using 1 of 3 established staging systems, depending on the circumstances. Paramount among these were evaluations of tumor load, liver function, and either functional status or time since metastasis. Both gender and age might play a role in the likelihood of survival. Metastases might be treatable with checkpoint inhibitors if they undergo unusual mutations. Recently, tebentafusp as a 1st-line treatment at the 1st interim analysis of a randomized phase 3 trial provided 6 months longer median overall survival compared to the investigator’s choice, mostly pembrolizumab; these treatments are currently applicable to selected patients. A large meta-analysis found that surgical treatment was associated with a 6-month longer median overall survival compared to conventional chemotherapy. The final frontier of curing metastatic uveal melanoma will be reached through the promotion of dormancy of micrometastases, harmonization of surveillance protocols, promotion of staging, identification of predictive factors, initiation of controlled clinical trials, and standardization of reporting.

Source: sciencedirect.com/science/article/pii/S1350946222000015