Metastatic Uveal Melanoma: Treatment Strategies and Survival-Results from the Dutch Melanoma Treatment Registry

Anouk Jochems; Monique K van der Kooij; Marta Fiocco; Maartje G Schouwenburg; Maureen J Aarts; Alexander C van Akkooi; Franchette W P J van den Berkmortel; Christian U Blank; Alfonsus J M van den Eertwegh; Margreet G Franken; JanWillem B de Groot; John B A G Haanen; Geke A P Hospers; Rutger H Koornstra; Wim H J Kruit; Marieke Louwman; Djura Piersma; Rozemarijn S van Rijn; Karijn P M Suijkerbuijk; Albert J Ten Tije; Gerard Vreugdenhil; Michel W J M Wouters; Michiel C T van Zeijl; Koos J M van der Hoeven; Ellen Kapiteijn

doi:10.3390/cancers11071007

Metastatic Uveal Melanoma: Treatment Strategies and Survival-Results from the Dutch Melanoma Treatment Registry

Cancers (Basel). 2019 Jul 18;11(7):1007. doi: 10.3390/cancers11071007.

Authors

Anouk Jochems^{1

2}, Monique K van der Kooij³, Marta Fiocco^{4

5}, Maartje G Schouwenburg^{3

6}, Maureen J Aarts⁷, Alexander C van Akkooi⁸, Franchette W P J van den Berkmortel⁹, Christian U Blank¹⁰, Alfonsus J M van den Eertwegh¹¹, Margreet G Franken¹², JanWillem B de Groot¹³, John B A G Haanen¹⁰, Geke A P Hospers¹⁴, Rutger H Koornstra¹⁵, Wim H J Kruit¹⁶, Marieke Louwman¹⁷, Djura Piersma¹⁸, Rozemarijn S van Rijn¹⁹, Karijn P M Suijkerbuijk²⁰, Albert J Ten Tije²¹, Gerard Vreugdenhil²², Michel W J M Wouters^{6

8}, Michiel C T van Zeijl^{3

6}, Koos J M van der Hoeven^{3

15}, Ellen Kapiteijn³

Affiliations

¹ Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, po box 9600, 2300 RC Leiden, The Netherlands. [email protected].
² Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands. [email protected].
³ Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, po box 9600, 2300 RC Leiden, The Netherlands.
⁴ Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Albinusdreef 2, po box 9600, 2300 RC Leiden, The Netherlands.
⁵ Mathematical Institute Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands.
⁶ Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.
⁷ Department of Medical Oncology, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
⁸ Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
⁹ Department of Medical Oncology, Zuyderland Medical Centre, 6130 MB Sittard-Geleen, The Netherlands.
¹⁰ Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
¹¹ Department of Medical Oncology, VU Medical Centre, de Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands.
¹² Department of Health Technology Assessment, Institute for Medical Technology Assessment and Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, 3000 DR Rotterdam, The Netherlands.
¹³ Department of Medical Oncology, Isala Oncological Center, 8000 GK Zwolle, The Netherlands.
¹⁴ Department of Medical Oncology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
¹⁵ Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6500 HB Nijmegen, The Netherlands.
¹⁶ Department of Medical Oncology, Erasmus MC Cancer Institute, Molewaterplein 40, 3000 CA Rotterdam, The Netherlands.
¹⁷ Netherlands Comprehensive Cancer Organisation, PO Box 19079, 3501 DB Utrecht, The Netherlands.
¹⁸ Department of Medical Oncology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, The Netherlands.
¹⁹ Department of Medical Oncology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.
²⁰ Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
²¹ Department of Medical Oncology, Amphia Ziekenhuis, Langendijk 175, 4819 EV Breda, The Netherlands.
²² Department of Medical Oncology, Maxima Medisch Centrum, de Run 4600, 5500 MB Veldhoven, The Netherlands.

Abstract

Uveal melanoma (UM) is the most common primary intraocular tumor in adults. Up to 50% of UM patients will develop metastases. We present data of 175 metastatic UM patients diagnosed in the Netherlands between July 2012 and March 2018. In our cohort, elevated lactate dehydrogenase level (LDH) is an important factor associated with poorer survival (Hazard Ratio (HR) 9.0, 95% Confidence Interval (CI) 5.63-14.35), and the presence of liver metastases is negatively associated with survival (HR 2.09, 95%CI 1.07-4.08). We used data from the nation-wide Dutch Melanoma Treatment Registry (DMTR) providing a complete overview of the location of metastases at time of stage IV disease. In 154 (88%) patients, the liver was affected, and only 3 patients were reported to have brain metastases. In 63 (36%) patients, mutation analysis was performed, showing a GNA11 mutation in 28.6% and a GNAQ mutation in 49.2% of the analyzed patients. In the absence of standard care of treatment options, metastatic UM patients are often directed to clinical trials. Patients participating in clinical trials are often subject to selection and usually do not represent the entire metastatic UM population. By using our nation-wide cohort, we are able to describe real-life treatment choices made in metastatic UM patients and 1-year survival rates in selected groups of patients.

Keywords: metastatic uveal melanoma; prognostic factor; survival; treatment strategy; uveal melanoma.