Dr Marlana M. Orloff provides an overview of the treatment landscape for metastatic uveal melanoma.
For patients with metastatic uveal melanoma, what are the treatment options?
Marlana M. Orloff, M.D.: Metastatic uveal melanoma is unique in that when patients recur, close to 90% or more recur in their liver. For this reason, when we’re talking with a patient about treatments, we can often talk to them about liver-directed or local regional therapy where we treat just the liver or systemic therapies that treat the whole body. Historically, uveal melanoma has been lumped in with skin melanoma, and the treatments that we’ve used for systemic management and systemic treatment have been skin melanoma treatments. However, we know that uveal melanoma is a very different disease than skin melanoma, and that’s why these treatments often didn’t work very well. It wasn’t until 2022 that we had our first FDA-approved therapy specific for uveal melanoma, a drug called tebentafusp, or Kimmtrak.
How do you choose the best treatment for each patient?
Marlana M. Orloff, M.D.: When a patient with metastatic uveal melanoma comes to talk about different treatment options, we look at a few different things to determine what the right next step might be. One of the first things we look at is their HLA [human leukocyte antigen] type. The drug that has been FDA approved for the treatment of metastatic uveal melanoma is restricted to patients who are HLA-A*02:01 positive. This matters because Kimmtrak acts like a magnet to drag the immune system over to the cancer cells. And the way that this drug engages with the patient’s immune system is through something called HLA. So it’s very important that a patient is the right HLA for this drug to work. For patients who are HLA-A*02:01 positive, we may choose Kimmtrak as a treatment choice. For patients who are HLA-A2 negative, we can sometimes look at those liver-directed or regional therapies or clinical trials.
When a patient’s diagnosed with metastatic uveal melanoma, it’s important that they talk to the physician about getting a blood test to determine their HLA type. Because again, knowing your HLA type and knowing if you’re HLA-A*02:01 positive may be the determining factor of whether or not Kimmtrak is a treatment option.
Transcript edited for clarity.