Treatments for uveal melanoma

The choice of treatment depends on the patient's age, the size of the tumour, its location in the eye, its extension beyond the sclera (white of the eye) and any histological analysis. One of the key concerns is to preserve the patient’s sight. Conservative treatments, which destroy or remove the tumor while preserving the eyeball, are based on Curietherapy or protontherapy. 
Particular attention is also paid to patients at high risk of relapse. If they have a tumor larger than 15mm, or a genome alteration on chromosomes 3 or 8, these patients are intensively monitored as part of a major study, called SALOME and coordinated by Institut Curie, to detect metastases as early as possible. The study is already recommending follow-up MRI imaging every six months. The study is already recommending follow-up MRI imaging every six months.

Curietherapy for uveal melanoma

Institut Curie is unique in its ability to treat small tumors in the anterior part of the eye using a disk of radioactive iodine (iodine 125). This technique, known as Curietherapy, involves applying a radioactive source directly to the eye, protecting the eyelids and lacrimal glands. Local tumor control is achieved in 95% of cases.

Proton therapy for uveal melanoma

Proton therapy consists in irradiating tumors to destroy them, with extreme precision. With protons, the radiation dose reaches the tumor in a very narrow beam, preserving as much as possible of the healthy tissue around the tumor, whose depth can be better controlled. Proton therapy is an advantageous alternative to enucleation, since it enables most patients to preserve their eyes and their vision.
Institut Curie has one of only two proton therapy centers in France, at its Orsay site (91). It is the world's leading ophthalmic proton therapy center in terms of the number of patients treated. One treatment room is dedicated to the treatment of ophthalmic tumors.

Uveal melanoma surgery

Removal of uveal melanoma with preservation of the eye is only possible for certain tumors. If the tumor is too large, or in the event of recurrence or major complications with the conservation treatment, surgical removal of the eye may be required (enucleation). Physicians then implant a coral bead, onto which the eye muscles are grafted.

Immunotherapy for uveal melanoma

In the event of metastatic relapse, patients may be offered immunotherapy with Tebentafusp if they possess the human leukocyte antigen HLA*A02:01, the most frequent HLA form in Europe, affecting around 45% of the population. This HLA histocompatibility factor is present on every cell in the human body and has a role that could be compared to that of an identity card, passed down from parent to child. Tebentafsup is only active if the patient possesses HLA*A02:01. If Tebentafsup fails, or if the patient is not eligible, other immunotherapies are less effective. Nevertheless, a recent discovery by Institut Curie, following analysis of the genetic background of a thousand patients, has identified a new predisposition gene for this disease, MBD4. Patients carrying a mutation in the MBD4 gene have tumors associated with high mutation rates, which significantly increases the efficacy of immunotherapies.