Search

Background: Targeted therapies for metastatic uveal melanoma have shown limited benefit in biomarker-unselected populations. The Treat20 Plus study prospectively evaluated the feasibility of a precision oncology strategy in routine clinical practice., Patients and Methods: Fresh biopsies were analyzed by high-throughput genomics (whole-genome, whole-exome, and RNA sequencing). A multidisciplinary molecular and immunologic tumor board (MiTB) made individualized treatment recommendations based on identified molecular aberrations, patient situation, drug, and clinical trial availability. Therapy selection was at the discretion of the treating physician. The primary endpoint was the feasibility of the precision oncology clinical program., Results: Molecular analyses were available for 39/45 patients (87%). The MiTB provided treatment recommendations for 40/45 patients (89%), of whom 27/45 (60%) received ≥1 matched therapy. First-line matched therapies included MEK inhibitors (n = 15), MET inhibitors (n = 10), sorafenib (n = 1), and nivolumab (n = 1). The best response to first-line matched therapy was partial response in one patient (nivolumab based on tumor mutational burden), mixed response in two patients, and stable disease in 12 patients for a clinical benefit of 56%. The matched therapy population had a median progression-free survival and overall survival of 3.3 and 13.9 months, respectively. The growth modulation index with matched therapy was >1.33 in 6/17 patients (35%) with prior systemic therapy, suggesting clinical benefit., Conclusions: A precision oncology approach was feasible for patients with metastatic uveal melanoma, with 60% receiving a therapy matched to identify molecular aberrations. The clinical benefit after checkpoint inhibitors highlights the value of tumor mutational burden testing., Competing Interests: Conflict of interest statement SL reports travel and advisory board support from Immunocore and Bayer. CP reports speaker honoraria from Bristol-Myers Squibb, Novartis, Daiichi-Sankyo, EUSA Pharma and Sirtex Medical and advisory honoraria from EUSA Pharma. MS is employee of Alacris Theranostics. TK is employee of Alacris Theranostics. SO reports consultancy fees from Astra Zeneca, Bristol-Myers Squibb, Janssen Biotech, Merck. DTR reports Honoraria from Lilly, Bristol-Myers Squibb and Advisory Honoraria from Bayer and Alacris Theranostics. KK reports advisory board and conference honoraria from Merck, Sanofi, Merck Sharp & Dohme, Glycotope, Roche, Novartis and Bristol-Myers Squibb. CU reports consulting fees from Sanofi, grant for educational activities form Galderma, Beiresdorf and Almirall. GP reports consulting fees and grant for educational activities from Amgen. Novartis, Sun Pharma. Bristol-Myers Squibb, Merck Sharp & Dohme. FK is co-founder of Aignostics GmbH and has received consulting support from Roche, Novartis, Bristol-Myers Squibb, Lilly, Agilent and Iomedico. AJ reports Consultant fees from Novartis, Roche, Boehringer, Allergan, Bayer. MLY is an employee and shareholder of Alacris Theranostics. UK reports consulting fees for Merck Sharp & Dohme, travel support from Merck Serono, Pfizer, grant for educational activities from Merck Serono, Bristol-Myers Squibb, Pierre-Fabre. FK, MD, ES, GD, ML, SB, RS have no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)