Attempts to reduce mortality in patients with uveal melanomas
Bechrakis N. E.1, Keilholz U.2
1Augenklinik, 2Medizinische Klinik III, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin
Purpose: The ophthalmic treatment modality of primary uveal melanomas has no direct influence on the evolution of metastatic disease, unless it results in inadequate local tumour control, which increases the metastatic risk.
Method: In order to increase patient survival it is therefore mandatory not only to treat the intraocular tumour successfully, but also to identify clinically significant prognostic factors and develop novel adjuvant treatment modalities. The development of vaccination protocols targeting specific melanoma and/or tumour antigens (tyrosinase peptides, MAGE, etc) has gained increasing importance and is currently evaluated in metastasis-free high-risk patients with the addition of further immunologic stimuli such as GM-CSF, KLH and others to augment the immunogenicity of the used vaccines. Up to date no effective treatment of metastases of uveal melanoma was available, limiting the median survival of patients with metastases to approx. 5 months. In the last few years, median survival of selected patients with metastatic disease could be increased to more than 14 months by various chemotherapy regimes, including intrahepatic or intravenous fotemustine infusions. Novel systemic chemotherapy protocols are currently being evaluated based on chemosensitivity studies. The effectiveness of the combination of gemcitabine and
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