Retrospective study of tolerability and efficacy of chemosaturation in combination with systemic therapy for metastatic uveal melanoma

Metastatic disease occurs in approximately 40% of patients with uveal melanoma (UM), with the liver as predominant site of metastasis (>90%). Treatment options include immune checkpoint inhibitors (ICIs), the bispecific fusion protein tebentafusp, and liver-directed therapies such as chemosaturation. Median overall survival with these approaches is approximately 1 year. A retrospective study at Eberhard Karls University (Tübingen, Germany) evaluated efficacy and tolerability of administering systemic therapy (ICIs or tebentafusp) within 40 days of chemosaturation with percutaneous hepatic perfusion (CS-PHP). The study included 10 patients with hepatic metastatic UM; 7 received ICI with CS-PHP and 3 received tebentafusp with CS-PHP. Hepatic disease control was achieved in all patients, with partial response in 7 patients and stable disease in 3 patients. Chemosaturation was associated mainly with pancytopenia (5 patients). Grade 1-3 immune-related adverse events among ICI-treated patients included autoimmune thyroiditis (one patient), hypophysitis (one patient), hepatitis (one patient), and dermatitis (one patient). The authors conclude that administering systemic therapy within the defined time interval around chemosaturation can achieve disease control with acceptable tolerability.