Did you know that uveal melanoma (UM), also known as ocular or choroidal melanoma, is the most common form of eye cancer? Uveal melanoma arises from parts of the uveal tract — the choroid, ciliary body, or iris.
Castle Biosciences (www. CastleBiosciences.com), with analytical laboratories in Phoenix, Arizona, provides the DecisionDx-UM test that measures the gene expression profile (GEP) of a patient’s tumor and identifies with high accuracy the likelihood and risk of metastasis. Clinical medical record reviews and the literature show that physicians and patients use the results of the DecisionDx-UM test to help direct therapy.
The DecisionDx-UM test for uveal melanoma determines the molecular signature of a patient’s tumor. The results of the test provide knowledge regarding the risk of near term metastasis (five years). Tumors with a Class 1 signature are associated with a good prognosis and a low potential to metastasize while tumors with a Class 2 signature have a high potential to spread.
As with other cancers, traditional clinical staging factors have been known for some time. These include:
- Large tumor size
- Ciliary body involvement (this is a highly vascularized area; from here cancer cells can travel to other body areas, such as the liver, more easily)
- Presence of orange pigment overlying the tumor
- Age at diagnosis
- Pathological findings such as epithelioid (versus spindle) morphology
However, unlike skin melanomas, these clinical factors have poor accuracy; thus these staging factors have not been used by ocular oncologists to direct therapy. The development of this gene expression profile test was to determine if the genomic makeup of the tumor would prove to be more accurate and thus have clinical utility.
If uveal melanoma spreads, it is more likely to spread via the blood, one of the reasons why metastases often appear in the liver first and also why ciliary body involvement is a likely indicator of future metastatic disease. The main goals of treatment of uveal melanoma are to reduce the risk of metastasis, prevent local growth and destruction of ocular tissues, and preserve vision to the extent possible. While approximately half of uveal melanoma tumors will metastasize at some point after diagnosis of the primary eye tumor, less than 3% present with detectable metastasis at the time of primary eye tumor diagnosis. Today, treatment of the primary eye tumor can be highly effective with primary tumor cure rates reported to be greater than 90%. Thus the main clinical issue facing ocular oncologists and patients is accurately staging the risk of metastasis.
The DecisionDx-UM can help patients and ocular oncologists create an individual plan for the frequency and intensity of monitoring for metastatic disease as well as prophylactic therapy for high risk patients. An 18-month medical record analysis of patients tested with DecisionDx-UM for risk of metastasis indicated that:
- In patients with a low risk of metastasis (Class 1) result, 96% of patients were under a low intensity surveillance plan
- In patients with a high risk of metastasis (Class 2) result, 95% of patients were under a high intensity surveillance plan
- 23% of patients were offered prophylactic therapy and 23% of patients were referred to clinical trials
In addition to having a direct impact on therapy decisions, prognostic testing has also been shown to improve life-planning for patients and their families.
The DecisionDx-UM test should not be mistaken for chromosome 3 (monosomy 3) testing. In all studies, the DecisionDx-UM test was found to be statistically and clinically superior to chromosome 3 in predicting metastasis in comparisons made in the same patients.
The DecisionDx-UM test can only be ordered by a physician, most commonly an ocular oncologist, retinal specialist, or ophthalmologist and requires a sample of the tumor. For patients undergoing radiation therapy the sample needs to be taken before radiation is delivered to the tumor.
For more information about the DecisionDx-UM test and how it can be ordered, visit the Castle Biosciences website at www.CastleBiosciences.com
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Tom Cockley is president of Gulden Ophthalmics and is the third generation of the nearly 75-year-old visionary company that brings innovative, time-saving, utilitarian products to vision and health care professionals.
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