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Clin Ophthalmol. 2014 Dec 3;8:2449-60. doi: 10.2147/OPTH.S70839. eCollection 2014.

Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses.

Author information

1
Michigan State University Medical School and Retina Specialists of Michigan, Grand Rapids, MI, USA.
2
Castle Biosciences, Friendswood, TX, USA.
3
Washington University School of Medicine in St Louis, St Louis, MO, USA.
4
Retina Consultants of Alabama and University of Alabama Birmingham, Birmingham, AL, USA.

Abstract

OBJECTIVE:

Assess current clinical practices for uveal melanoma (UM) and the impact of molecular prognostic testing on treatment decisions.

DESIGN:

Cross-sectional survey and sequential medical records review.

PARTICIPANTS:

Ophthalmologists who treat UM.

METHODS:

(A) Medical records review of all Medicare beneficiaries tested by UM gene expression profile in 2012, conducted under an institutional review board-approved protocol. (B) 109 ophthalmologists specializing in the treatment of UM were invited to participate in 24-question survey in 2012; 72 were invited to participate in a 23-question survey in 2014.

MAIN OUTCOME MEASURES:

Responses analyzed by descriptive statistics, frequency analyses (percentages, Tukey, histograms), and Fisher's exact test. Descriptive presentation of essay answers.

RESULTS:

The review of Medicare medical records included 191 evaluable patients, 88 (46%) with documented medical treatment actions or institutional policies related to surveillance plans. Of these 88, all gene expression profiling (GEP) Class 1 UM patients were treated with low-intensity surveillance. All GEP Class 2 UM patients were treated with high-intensity surveillance (P<0.0001 versus Class 1). There were 36 (19%) with information concerning referrals after initial diagnosis. Of these 36, all 23 Class 2 patients were referred to medical oncology; however, none of the 13 Class 1 patients were referred (P<0.0001 versus Class 1). Only Class 2 patients were recommended for adjunctive treatment regimens. 2012 survey: 50 respondents with an annual median of 35 new UM patients. The majority of respondents (82%) performed molecular analysis of UM tumors after fine needle biopsy (FNAB); median: 15 FNAB per year; 2014 survey: 35 respondents with an annual median of 30 new UM patients. The majority offered molecular analyses of UM tumor samples to most patients. Patients with low metastatic risk (disomy 3 or GEP Class 1) were generally assigned to less frequent (every 6 or 12 months) and less intensive clinical visits. Patients with high metastatic risk (monosomy 3 or GEP Class 2) were assigned to more frequent surveillance with hepatic imaging and liver function testing every 3-6 months. High-risk patients were considered more suitable for adjuvant treatment protocols.

CONCLUSION:

The majority of ophthalmologists treating UM have adopted molecular diagnostic tests for the purpose of designing risk-appropriate treatment strategies.

KEYWORDS:

Medicare; gene expression profiling (GEP); molecular diagnostic test; uveal melanoma

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