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Uveale Melanome

Update Ophthalmoonkologie 2021

Uveal melanoma

Update ophthalmic oncology 2021

  • Update Onkologie
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Das uveale Melanom (UM) ist der häufigste intraokuläre Tumor des Erwachsenen. Bei der Therapie des Primarius sind bestrahlungsbasierte Methoden nach wie vor Mittel der ersten Wahl. Aufgrund der hohen lokalen Tumorkontrolle durch Brachytherapie und Protonentherapie sind Lokalrezidive, die mit einem erhöhten Metastasierungsrisiko einhergehen, selten geworden. Bei der ophthalmologischen Nachsorge stehen neben der Sicherstellung einer langfristigen Tumorkontrolle v. a. die rechtzeitige Detektion und Behandlung radiogener Nebenwirkungen im Vordergrund. Ansätze zur Reduktion radiogener Nebenwirkungen sind Gegenstand der aktuellen Forschung. Die genaue molekulare Charakterisierung der Tumoren ermöglicht eine bessere Einschätzung der Prognose, hat aber wegen fehlender therapeutischer Konsequenzen bei limitierten Therapieoptionen in der metastasierten Therapiesituation bisher keinen Einzug in die klinische Routine gehalten. Bis dato existiert keine adjuvante Therapie, die das Risiko der Entwicklung einer Metastasierung verringert. Der Fokus der Nachsorge liegt auf der frühzeitigen Detektion der typischen und prognostisch führenden hepatischen Metastasierung. Auch die aktuelle Therapiestrategie in der metastasierten Situation fokussiert vor dem Hintergrund fehlender effektiver Systemtherapien auf leberspezifische Therapieverfahren, jedoch fehlen randomisierte, kontrollierte Studien zum systematischen Vergleich der zur Verfügung stehenden lokal interventionellen Therapien. Mit Tebentafusp wird aller Voraussicht nach in naher Zukunft erstmals eine vielversprechende Immuntherapie zur Behandlung des metastasierten UM zur Verfügung stehen. In dieser Arbeit geben wir einen Überblick über die aktuellen Entwicklungen in Diagnostik und Therapie sowie potenzielle zukünftige Therapiestrategien beim UM.

Abstract

Uveal melanoma (UM) is the most frequent intraocular tumor in adults. In the treatment of the primary tumor, radiation-based methods are still considered method of first choice. Since high local tumor control can be achieved by brachytherapy and proton beam therapy, local tumor recurrence, which is associated with increased risk of metastatic spread, is rare. Besides securing local tumor control, ophthalmological follow-up aims at early detection and adequate treatment of potential radiation-induced side effects. Approaches to reduce radiation-induced side effects are being currently investigated. Detailed molecular characterization of UM allows for better estimation of prognosis; however, thus far this remains without therapeutic consequences due to limited treatment options in the metastatic setting. To date, there is no effective adjuvant treatment that reduces the risk of developing metastases. Main focus of follow-up is the early detection of liver metastases that are a typical manifestation and determine prognosis. Current treatment strategies in the metastatic setting focus upon liver-directed approaches considering the lack of effective systemic treatment options. However, randomized controlled trials to systematically compare the available liver-specific therapies are lacking. With tebentafusp there is an upcoming, promising immunotherapeutic treatment approach in metastatic uveal melanoma for the first time. In this article we review current developments in diagnosis, treatment, and potential future treatment strategies in uveal melanoma.

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Authors and Affiliations

  1. Campus Benjamin Franklin, Klinik für Augenheilkunde, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    A. I. Riechardt & A. M. Joussen

  2. Klinik für Hämatologie, Onkologie und Tumorimmunologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    C. A. Peuker & S. Ochsenreither

  3. Charité Comprehensive Cancer Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland

    S. Ochsenreither

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  1. A. I. Riechardt
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  4. A. M. Joussen
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Interessenkonflikt

A.I. Riechardt, C.A. Peuker, S. Ochsenreither und A.M. Joussen geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Riechardt, A.I., Peuker, C.A., Ochsenreither, S. et al. Uveale Melanome. Onkologe 27, 595–601 (2021). https://doi.org/10.1007/s00761-021-00951-6

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  • DOI: https://doi.org/10.1007/s00761-021-00951-6

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