Current Therapies and Potential Strategies for Uveal Melanoma.

Abstract

Background/objectives: Uveal melanoma (UM) is a rare but deadly ocular cancer. This review summarizes the characteristics of uveal melanoma and current therapeutic options for primary uveal melanoma and metastatic uveal melanoma, and introduces recent development of therapeutic strategies in preclinical animal studies and clinical trials.

Methods: The literature search was conducted to identify relevant articles for UM studies. It was performed using PubMed for articles in English until March 2025. Information on clinical trials was also obtained from ClinicalTrial.gov.

Results: Uveal melanoma originates from melanocytes, similar to skin melanoma. However, uveal melanoma has different mutations from skin melanoma. Thus, chemotherapy and immunotherapy, which are effective for skin melanoma, are ineffective for uveal melanoma. Current therapies for UM include radiation therapy, surgical resection, liver-directed therapies, and recently FDA-approved tebentafusp. Although a wide variety of available and newly developed therapies have been tested in clinical trials for UM, tebentafusp is the only FDA-approved therapy for metastatic UM. Given the excessive expression of vascular endothelial growth factor (VEGF) in UM patients with metastatic diseases, anti-VEGF strategies are being tested in clinical trials and pre-clinical animal models.

Conclusions: This review summarizes an overview of current therapies and the development of therapeutic strategies in clinical trials and pre-clinical animal models. Despite successful control of primary tumors, 50% of UM patients still experience metastasis in the liver. Although tebentafusp improves the overall survival (OS) of a certain population of UM patients, robust strategies for preventing UM metastasis represent a critical unmet need. Further investigations of the heterogeneity of UM cells and mechanisms of UM metastasis are needed in the future.