Twenty years of metastatic uveal melanoma management: Real-world experience from a comprehensive cancer center in a low- and middle-income country (LMIC).

Abstract

9545 Background: Uveal melanoma (UM) is a rare malignancy arising from melanocytes of the uveal tract and accounts for 85% of primary ocular malignancies. Despite effective local control, 10-50% of patients develop metastatic disease, which is associated with poor prognosis and a median overall survival (OS) of approximately one year. Until recently, no effective standard systemic therapy existed for metastatic UM. Real-world data especially from LMICs remain lacking. This study evaluates the clinical characteristics, treatment patterns, and survival outcomes of patients with metastatic UM treated in a LMIC. Methods: This retrospective study included adult patients with metastatic UM treated and followed at King Hussein Cancer Center in Amman, Jordan between January 2006 and December 2025. Collected data included baseline demographic and clinical characteristics, metastatic and treatment patterns. Descriptive and survival analyses were conducted using JASP software (version 0.95.4). A two-sided P value <0.05 was considered statistically significant. Results: Among 125 patients with UM, 31 (24.8%) had metastatic disease, including two patients with metastasis at initial presentation. Median age at diagnosis was 51 years, and 61.3% were males. ECOG performance status was 0–2 in 81.5% of patients. Hepatic-only metastasis occurred in 51.6% of patients, combined hepatic and extrahepatic in 38.7%, and extrahepatic-only in 9.7%, with 58.6% classified as M1a disease. Median time to distant metastasis was 25 months. Median OS from initial UM diagnosis was 35 months, while median post-metastatic OS (PM-OS) was 10 months. First-line Immunotherapy was associated with significantly improved PM-OS compared to Dacarbazine (median 11 vs 5 months; P = 0.034), with 24-month PM-OS of 44.4% vs 0% respectively. Treatments included Immunotherapy, chemotherapy, Targeted therapy in one patient, local interventions, and best supportive care (Table). Conclusions: Metastatic UM remains associated with poor survival outcomes in this real-world cohort. First-line Immunotherapy was associated with longer survival compared to chemotherapy. This study highlights ongoing unmet outcomes needs and underscores disparities in access to emerging therapies, such as Tebentafusp, in LMICs. Broader availability of novel agents and inclusion of patients from LMICs in clinical trials are required. First-line Treatments Second-line Treatments Third line Treatments Additional Local interventions Pembrolizumab (n=15) Dacarbazine (n=7) Carboplatin plus Paclitaxel (n=1) Radiotherapy (n=9) Nivolumab and Ipilimumab (n=4) Nivolumab and Ipilimumab (n=1) Single agent Paclitaxel (n=1) Microwave ablation (n=1) Dacarbazine (n=3) Surgery (n=1) Darovasertib and Crizotinib (n=1) Best supportive care only (n=8)