Adjuvant Sunitinib for High-Risk Uveal Melanoma
Ophthalmology, February 2018
Primary uveal melanoma is the most common primary intraocular malignancy in adults, and effective adjuvant treatment is lacking. Despite definitive treatment of the primary tumor, systemic metastases occur in up to 50% of patients. Valsecchi et al. performed a retrospective study of patients with high-risk primary uveal melanoma to compare survival rates between those who received adjuvant sunitinib and those who did not (institutional historical controls). The adjuvant treatment produced promising results that warrant investigation in prospective studies.
For their study, the authors utilized records from the uveal melanoma cytogenetic database of the Wills Eye Hospital Oncology Service.
Outcomes for adults who received adjuvant sunitinib for 6 months (n = 54; median age, 56 years) were compared with outcomes for historical controls in the same risk category (n = 74; median age, 62 years). Kaplan-Meier and Cox proportional hazards models were used to assess overall survival, and propensity scores were used to adjust for nonrandom assignment to sunitinib therapy.
Patients in the sunitinib group exhibited worse cytogenetic or molecular features, had smaller tumors, and were younger. There were 51 deaths: 14 (26%) in the sunitinib group and 37 (50%) among controls. According to univariate analysis, patients treated with sunitinib had longer survival (hazard ratio, 0.53; p = .041). Multivariate Cox regression analysis showed a significant relationship between sunitinib use and age as a dichotomous variable (p = .003).
Factors that were significant in predicting overall survival were cytogenetic/molecular status (p = .015), T-size category (p = .022), gender (p = .040), and adjuvant sunitinib in patients under 60 years of age (p = .004). These findings were confirmed by propensity score analysis.
Although adjuvant sunitinib was associated with longer survival in this study, the findings are limited by the retrospective nature of the research. As a follow-up to this work, the authors are conducting a randomized noncomparative trial of sunitinib and valproic acid. Data obtained from that trial will dictate whether a placebo-controlled study of adjuvant sunitinib should be considered.
The original article can be found here.