Efficacy of combination immunotherapy in patients with generalized uveal melanoma: real clinical practice

Introduction. Uveal melanoma is a rare malignant neoplasm that develops from melanocytes of the choroid of the eyeball. It occupies a leading position in the structure of intraocular malignant neoplasms. Aim. Тo analyze real-world clinical practice data on the use of nivolumab in combination with ipilimumab to treat patients with metastatic uveal melanoma. Mat erials and methods. Fifteen patients with metastatic uveal melanoma received therapy with nivolumab and ipilimumab. The median age of patients was 53 years, the minimum age was 24 years, and the maximum was 71 years. The analysis included 9 (60%) men and 6 (40%) women. Evaluation of the functional status showed that 4 (26.7%) patients had ECOG 0 points, 6 (40%) – ECOG 1 and 5 (33.3%) – ECOG 2. Results. The median relapse-free survival after enucleation of the eye was 61 months. Objective response to immunotherapy was achieved in 33.3% of patients, and the disease control rate was 86.6%. However, 4 (26.6%) patients discontinued therapy due to hepatotoxicity. The study noted that the median overall survival from the start of therapy with nivolumab in combination with ipilimumab reaches 8 months. It was found that the functional status of patients and the response to therapy are important predictors of survival, where patients with better indicators have a significantly higher life expectancy. Thus, patients with ECOG 0 show a median overall survival of 18 months. Conclusion. Immune checkpoint inhibitors remain the mainstay of treatment for patients with metastatic uveal melanoma. Combined immunotherapy with nivolumab and ipilimumab can be considered as a possible treatment option for this category of patients in conditions of limited therapeutic options.