Dr Orloff on Treatment Strategies for Rapidly Progressing Uveal Melanoma

Marlana M. Orloff, MD, discusses optimal therapeutic approaches for patients with uveal melanoma that is rapidly progressing.

“We don’t have the tools in our toolbox the way that [we do for] cutaneous melanoma…we have treatments that certainly can work in more than half of patients. That said, there are clinical trials looking at drugs that elicit higher response rates. If and when they are approved, they will be a nice tool.”

Marlana M. Orloff, MD, associate professor, Jefferson University; physician, Department of Medical Oncology, Sidney Kimmel Cancer Center, discusses optimal treatment strategies for patients with aggressive uveal melanoma.

For patients with rapidly progressing tumors, the ideal approach is to initiate treatment with the highest likelihood of leading to tumor shrinkage or disease control, Orloff begins. Therapies with a high overall response rate (ORR) or rapid onset of action are therefore generally preferred in this setting, she says. However, unlike cutaneous melanoma, where highly effective therapies exist that benefit a significant proportion of patients, the therapeutic arsenal for this population is more limited, Orloff states.

Ongoing clinical trials are evaluating novel agents with the potential for higher ORRs, Orloff continues, adding that if these treatments receive regulatory approval, they could become valuable options for patients with aggressive disease. Additionally, liver-directed therapies have demonstrated high disease control rates in select patient populations and may be considered for those with rapidly progressing tumors, particularly in cases of liver metastases, she notes.

Conversely, some treatments that provide an overall survival (OS) benefit may not be the most effective first-line options for patients with rapidly progressing disease, Orloff states. These therapies may require more time to produce a clinical response, making them less suitable for individuals in need of urgent tumor control, she explains. Tailoring treatment selection based on tumor kinetics and individual patient factors remains crucial to optimizing outcomes, Orloff concludes.