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Immunotherapy for Uveal Melanoma.

Uveal melanoma is the most common primary intraocular tumor in adults. Before the mid-20th century, enucleation was the mainstay of treatment for uveal melanoma. Although this has since been replaced in most circumstances with globe-conserving therapies such as radiotherapy, with excellent associated rates of local control, rates of subsequent metastasis and metastatic death remain high. Approximately 50% of patients go on to develop metastatic disease, with the most common site of metastasis being the liver. Metastatic disease has been refractory to traditional chemotherapy, and alternative treatments such as surgical metastatectomy or chemoembolization have failed to significantly improve patient survival. The relatively new field of immunotherapy has provided rapidly emerging treatments for cancers such as melanoma based on targeting immune system checkpoints. Most attention is currently focused on blocking molecular targets such as cytotoxic T-lymphocyte antigen 4 (CTLA-4), an inhibitory molecule on T lymphocytes, and other inhibitory molecules including programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1). Blocking these specific immune modulators leads to immune system activation and ultimately to immune-mediated tumor regression.