Download PDF
Semin intervent Radiol 2024; 41(01): 020-026
DOI: 10.1055/s-0043-1777712
Review Article

Immunoembolization for the Treatment of Uveal Melanoma Hepatic Metastases

Carin F. Gonsalves
1   Interventional Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Uveal melanoma is the most common primary intraocular tumor in adults. Approximately 50% of patients develop metastatic disease despite successful treatment of the primary eye tumor. The liver is the most common site of metastatic disease occurring in more than 90% of patients. Clinical prognosis is dependent on the ability to control the growth of liver tumors. Locoregional therapies play an important role in stabilizing liver metastases, prolonging survival for patients with metastatic uveal melanoma. As overall survival is prolonged, the development of extrahepatic disease becomes more common. Immunoembolization, a form of liver-directed therapy, not only focuses on treating hepatic metastases by stimulating the local immune system to suppress the growth of liver tumors, but it potentially generates a systemic immune response delaying the growth of extrahepatic metastases as well. The following article discusses immunoembolization for the treatment of metastatic uveal melanoma including the rationale, mechanism of action, indications, contraindications, outcomes, and associated toxicities.

Keywords

uveal melanoma - immunoembolization - granulocyte macrophage-colony-stimulating factor - liver-directed therapy - interventional radiology


Publication History

Article published online:
14 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Aronow ME, Topham AK, Singh AD. Uveal melanoma: 5-year update on incidence, treatment, and survival (SEER 1973–2013). Ocul Oncol Pathol 2018; 4 (03) 145-151
    CrossrefPubMedGoogle Scholar
  • 2 Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye (Lond) 2017; 31 (02) 241-257
    CrossrefPubMedGoogle Scholar
  • 3 Shields CL, Shields JA. Ocular melanoma: relatively rare but requiring respect. Clin Dermatol 2009; 27 (01) 122-133
    CrossrefPubMedGoogle Scholar
  • 4 Ulmer A, Beutel J, Süsskind D. et al. Visualization of circulating melanoma cells in peripheral blood of patients with primary uveal melanoma. Clin Cancer Res 2008; 14 (14) 4469-4474
    CrossrefPubMedGoogle Scholar
  • 5 Krantz BA, Dave N, Komatsubara KM, Marr BP, Carvajal RD. Uveal melanoma: epidemiology, etiology, and treatment of primary disease. Clin Ophthalmol 2017; 11: 279-289
    CrossrefPubMedGoogle Scholar
  • 6 Yang J, Manson DK, Marr BP, Carvajal RD. Treatment of uveal melanoma: where are we now?. Ther Adv Med Oncol 2018; 10: 1758834018757175
    CrossrefPubMedGoogle Scholar
  • 7 van den Bosch T, van Beek JGM, Vaarwater J. et al. Higher percentage of FISH-determined monosomy 3 and 8q amplification in uveal melanoma cells relate to poor patient prognosis. Invest Ophthalmol Vis Sci 2012; 53 (06) 2668-2674
    CrossrefPubMedGoogle Scholar
  • 8 Cassoux N, Rodrigues MJ, Plancher C. et al. Genome-wide profiling is a clinically relevant and affordable prognostic test in posterior uveal melanoma. Br J Ophthalmol 2014; 98 (06) 769-774
    CrossrefPubMedGoogle Scholar
  • 9 Onken MD, Worley LA, Char DH. et al. Collaborative Ocular Oncology Group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma. Ophthalmology 2012; 119 (08) 1596-1603
    CrossrefPubMedGoogle Scholar
  • 10 Field MG, Decatur CL, Kurtenbach S. et al. PRAME as an independent biomarker for metastasis in uveal melanoma. Clin Cancer Res 2016; 22 (05) 1234-1242
    CrossrefPubMedGoogle Scholar
  • 11 Sato T. Locoregional management of hepatic metastasis from primary uveal melanoma. Semin Oncol 2010; 37 (02) 127-138
    CrossrefPubMedGoogle Scholar
  • 12 Spagnolo F, Caltabiano G, Queirolo P. Uveal melanoma. Cancer Treat Rev 2012; 38 (05) 549-553
    CrossrefPubMedGoogle Scholar
  • 13 Patel K, Sullivan K, Berd D. et al. Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res 2005; 15 (04) 297-304
    CrossrefPubMedGoogle Scholar
  • 14 Gonsalves CF, Eschelman DJ, Thornburg B, Frangos A, Sato T. Uveal melanoma metastatic to the liver: chemoembolization with 1,3-bis-(2-Chloroethyl)-1-nitrosourea. AJR Am J Roentgenol 2015; 205 (02) 429-433
    CrossrefPubMedGoogle Scholar
  • 15 Vogl T, Eichler K, Zangos S. et al. Preliminary experience with transarterial chemoembolization (TACE) in liver metastases of uveal malignant melanoma: local tumor control and survival. J Cancer Res Clin Oncol 2007; 133 (03) 177-184
    CrossrefPubMedGoogle Scholar
  • 16 Gonsalves CF, Eschelman DJ, Sullivan KL, Anne PR, Doyle L, Sato T. Radioembolization as salvage therapy for hepatic metastasis of uveal melanoma: a single-institution experience. AJR Am J Roentgenol 2011; 196 (02) 468-473
    CrossrefPubMedGoogle Scholar
  • 17 Klingenstein A, Haug AR, Zech CJ, Schaller UC. Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients. Cardiovasc Intervent Radiol 2013; 36 (01) 158-165
    CrossrefPubMedGoogle Scholar
  • 18 Eldredge-Hindy H, Ohri N, Anne PR. et al. Yttrium-90 microsphere brachytherapy for liver metastases from uveal melanoma: clinical outcomes and the predictive value of fluorodeoxyglucose positron emission tomography. Am J Clin Oncol 2016; 39 (02) 189-195
    CrossrefPubMedGoogle Scholar
  • 19 Gonsalves CF, Eschelman DJ, Adamo RD. et al. A prospective phase II trial of radioembolization for treatment of uveal melanoma hepatic metastasis. Radiology 2019; 293 (01) 223-231
    CrossrefPubMedGoogle Scholar
  • 20 Hughes MS, Zager J, Faries M. et al. Results of a randomized controlled multicenter phase III trial of percutaneous hepatic perfusion compared with best available care for patients with melanoma liver metastases. Ann Surg Oncol 2016; 23 (04) 1309-1319
    CrossrefPubMedGoogle Scholar
  • 21 Kanai T, Monden M, Sakon M. et al. New development of transarterial immunoembolization (TIE) for therapy of hepatocellular carcinoma with intrahepatic metastases. Cancer Chemother Pharmacol 1994; 33 (Suppl): S48-S54
    CrossrefPubMedGoogle Scholar
  • 22 Yoshida T, Sakon M, Umeshita K. et al. Appraisal of transarterial immunoembolization for hepatocellular carcinoma: a clinicopathologic study. J Clin Gastroenterol 2001; 32 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 23 Saito T, Tsuchiya T, Sato Y. et al. Effect of transarterial immunoembolization as preoperative treatment for hepatocellular carcinoma. Ann Cancer Res Therap 2011; 19: 26-33
    CrossrefPubMedGoogle Scholar
  • 24 Nakamoto Y, Mizukoshi E, Kitahara M. et al. Prolonged recurrence-free survival following OK432-stimulated dendritic cell transfer into hepatocellular carcinoma during transarterial embolization. Clin Exp Immunol 2011; 163 (02) 165-177
    CrossrefPubMedGoogle Scholar
  • 25 Dranoff G, Jaffee E, Lazenby A. et al. Vaccination with irradiated tumor cells engineered to secrete murine granulocyte-macrophage colony-stimulating factor stimulates potent, specific, and long-lasting anti-tumor immunity. Proc Natl Acad Sci U S A 1993; 90 (08) 3539-3543
    CrossrefPubMedGoogle Scholar
  • 26 Sullivan KL, Aoyama T, Sato T, McCue P. Safety of immunoembolization of normal swine liver with human GM-CSF (granulocyte macrophage colony stimulating factor) and ethiodol. J Vasc Interv Radiol 2001; 12: S132-S133
    PubMedGoogle Scholar
  • 27 Sato T, Eschelman DJ, Gonsalves CF. et al. Immunoembolization of malignant liver tumors, including uveal melanoma, using granulocyte-macrophage colony-stimulating factor. J Clin Oncol 2008; 26 (33) 5436-5442
    CrossrefPubMedGoogle Scholar
  • 28 Yamamoto A, Chervoneva I, Sullivan KL. et al. High-dose immunoembolization: survival benefit in patients with hepatic metastases from uveal melanoma. Radiology 2009; 252 (01) 290-298
    CrossrefPubMedGoogle Scholar
  • 29 Valsecchi ME, Terai M, Eschelman DJ. et al. Double-blinded, randomized phase II study using embolization with or without granulocyte-macrophage colony-stimulating factor in uveal melanoma with hepatic metastases. J Vasc Interv Radiol 2015; 26 (04) 523-32.e2
    CrossrefPubMedGoogle Scholar
  • 30 Gutjahr CJ, Gonsalves CF, Eschelman DJ, Frangos A, Meshekow JS, Sato T. Immunoembolization (IE) using 1500 mcg of granulocyte macrophage-colony stimulating factor (GM-CSF) and 2 million IU of interleukin-2 (IL-2) for the treatment of uveal melanoma (UM) hepatic metastases. J Vasc Interv Radiol 2014; 25: S26
    CrossrefPubMedGoogle Scholar
  • 31 Ford R, Gonsalves C, Adamo R. et al. Prolonged survival after treatment of hepatic uveal melanoma metastases using immunoembolization. J Vasc Interv Radiol 2019; 30: S140
    CrossrefPubMedGoogle Scholar
  • 32 Seedor RS, Orloff M, Sato T. Genetic landscape and emerging therapies in uveal melanoma. Cancers (Basel) 2021; 13 (21) 5503
    CrossrefPubMedGoogle Scholar
  • 33 Aoyama T, Mastrangelo MJ, Berd D. et al. Protracted survival after resection of metastatic uveal melanoma. Cancer 2000; 89 (07) 1561-1568
    CrossrefPubMedGoogle Scholar
  • 34 Akyuz M, Yazici P, Dural C. et al. Laparoscopic management of liver metastases from uveal melanoma. Surg Endosc 2016; 30 (06) 2567-2571
    CrossrefPubMedGoogle Scholar
  • 35 Mariani P, Almubarak MM, Kollen M. et al. Radiofrequency ablation and surgical resection of liver metastases from uveal melanoma. Eur J Surg Oncol 2016; 42 (05) 706-712
    CrossrefPubMedGoogle Scholar
  • 36 Zimmer L, Vaubel J, Mohr P. et al. Phase II DeCOG-study of ipilimumab in pretreated and treatment-naïve patients with metastatic uveal melanoma. PLoS One 2015; 10 (03) e0118564
    CrossrefPubMedGoogle Scholar
  • 37 Heppt MV, Heinzerling L, Kähler KC. et al. Prognostic factors and outcomes in metastatic uveal melanoma treated with programmed cell death-1 or combined PD-1/cytotoxic T-lymphocyte antigen-4 inhibition. Eur J Cancer 2017; 82: 56-65
    CrossrefPubMedGoogle Scholar
  • 38 Algazi AP, Tsai KK, Shoushtari AN. et al. Clinical outcomes in metastatic uveal melanoma treated with PD-1 and PD-L1 antibodies. Cancer 2016; 122 (21) 3344-3353
    CrossrefPubMedGoogle Scholar
  • 39 Piulats Rodriguez JM, De La Cruz Merino L, Espinosa E. et al. Phase II multicenter, single arm, open label study of nivolumab in combination with Ipilimumab in untreated patients with metastatic uveal melanoma. Ann Oncol 2018; 29: 442-466
    CrossrefPubMedGoogle Scholar
  • 40 Guez D, Eschelman D, Pan K. et al. Ipilimumab combined with immunoembolization for treatment of uveal melanoma metastatic to the liver. J Vasc Radiol 2019; 30: S141
    CrossrefPubMedGoogle Scholar
  • 41 Sato T, Nathan PD, Hernandez-Aya L. et al. Redirected T cell lysis in patients with metastatic uveal melanoma with gp100-directed TCR IMCgp100: overall survival findings. J Clin Oncol 2018; 36: 9521
    CrossrefPubMedGoogle Scholar
  • 42 Carvajal RD, Sacco J, Nathan P. et al. Safety, efficacy and biology of the gp100 TCR-based bispecific T cell redirector IMCgp100 in advanced uveal melanoma. Invest Ophthalmol Vis Sci 2018; 59: 3622
    PubMedGoogle Scholar
  • 43 Balasubramanya R, Selvarajan SK, Cox M. et al. Imaging of ocular melanoma metastasis. Br J Radiol 2016; 89 (1065): 20160092
    CrossrefPubMedGoogle Scholar