Outcome of an active surveillance programme for patients (pts) with uveal melanoma (UM) after primary curative therapy (PTx): Single institution 10-year experience

Abstract

Background: About 30% of pts withUMdevelop metastatic disease (MUM) despite PTx. MUMhas poor prognosis and no systemic treatment (STx) has been proven to improve overall survival (OS).The roleof active surveillance afterPTx is still controversial. Methods: We performed an outcome analysis of allUMpts prospectively registered onto our active surveillance programme after PTx. All pts had systemic staging at diagnosis and then 6-monthly liver imaging (CT triple-phase, MRI, ultrasound) and clinical review for the first 5 years and 12-monthly afterwards. Progression-free survival (PFS) was calculated from time of first systemic relapse to first disease progression, OS from time of first systemic relapse to death or latest FU. Results: Out of 169 pts registered between April 2008 and April 2018, 32 (19%) developed MUMduring surveillance: 14 pts (44%) relapsed<2 yrs, 14 (44%)>2 and<5 yrs, 4 (12%)>5 yrs fromPTx. Median FUis 46.8 mos.MUMpts characteristics: males 17 (53%); median age 59yrs (range 31-86);median tumour thickness at diagnosis 9mm (range 3-22); sites ofmetastases: liver only 10 (31%), liver+ other sites 19 (60%), extrahepatic only 3 (9%). Relapseswere asymptomatic and detected on surveillance imaging in 25 (78%) pts.Median duration to relapse after PTx is 27.4mos. Eight pts (25%) were upfront resectable (PRx) and underwent radical hepatic metastasectomies, 24 pts (75%) were non-resectable (NRx) and underwent immunotherapy (n=12), other systemic therapies (n=5) [4 chemotherapy, 1 BRAF inhibitor], locoregional Tx (n=3) [2 Delcath, 1 RFA], best supportive care (n=4). Atmedian FUof 46.8mos (0-120 mos), 27 pts have died and themedianOS is 13.5mos. PFS was longer in PRx pts compared toNRx pts (PFS: 9.8 vs 4.4 mos / OS: 20.7 vs 39.3mos). All 8 resectable pts developed further disease relapse [median time to hepatic relapse 9.8mons (range 5.2 -13.1)]. Conclusions: Our data indicate that active surveillance after PTx ofUMcan allow detection of asymptomatic potentially resectable liver metastases, especially in pts with high riskUM(i.e. thickness >5mm). Although durable remission after hepatic metastasectomy is rare, PFS and OS may be meaningfully prolonged.