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Luckett T, Ng CA, Lai-Kwon J, Kee D, Mulhern B, Joshua AM. Uncertainty and hope in people with metastatic uveal melanoma in the era of immunotherapy and targeted treatments: a theory-based qualitative study. BMC Cancer 2025; 25:939. [PMID: 40420014 PMCID: PMC12105258 DOI: 10.1186/s12885-025-14368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Accepted: 05/20/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND The advent of immunotherapies and targeted treatments has improved survival for some people with metastatic cancer but also increased prognostic uncertainty. To inform clinician-patient communication and supportive care, this study explored uncertainty-related coping among people with metastatic uveal melanoma (mUM) - a disease for which treatments have emerged especially suddenly. METHODS A qualitative approach was taken using semi-structured interviews. Participants with mUM were recruited through consumer organisations internationally. Interviews explored participant perspectives on the impacts of uncertainty and their related coping strategies. Analysis involved inductive coding followed by deductive coding against Mishel's (1988) theoretical framework of uncertainty in illness. RESULTS Seventeen people participated, including 10 from Australia. Participants described experiencing uncertainty as disempowering but also leveraged the opportunity it presented for remaining hopeful. Some participants used meta-cognition- alluded to as 'tricking' or 'fooling' themselves - to manage inconsistency between hoping for an exceptional response and accepting that benefits were likely to be modest at best. Most participants were able to maintain everyday normalcy but struggled to discuss their illness and treatment with family and friends. Participants reported heightened anxiety in the lead-up to routine scans and while awaiting results. CONCLUSIONS Coping with uncertainty in the era of immunotherapy and targeted treatments involves 'hoping for the best while preparing for the worst'. Supportive care is especially needed at the time of scans. Some patients may also benefit from help with talking to their social networks. Head-to-head comparisons are needed of differing psychological interventions.
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Affiliation(s)
- Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Building 10, Jones St, Ultimo, Sydney, New South Wales, NSW, 2007, Australia.
| | - Carrie-Anne Ng
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, NSW, 2007, Australia
| | - Julia Lai-Kwon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, VIC, 3000, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, NSW, 2065, Australia
| | - Damien Kee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, VIC, 3000, Australia
- Department of Medical Oncology, Austin Health, Melbourne, Victoria, VIC, 3084, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation (CHERE), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, NSW, 2007, Australia
| | - Anthony M Joshua
- The Kinghorn Cancer Centre, Saint Vincent's Hospital, Sydney, New South Wales, NSW, 2010, Australia
- Garvan Institute of Medical Research, University of New South Wales (UNSW), Sydney, New South Wales, NSW, 2010, Australia
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Szabó IL, Emri G, Ladányi A, Tímár J. Clinical Applications of the Molecular Landscape of Melanoma: Integration of Research into Diagnostic and Therapeutic Strategies. Cancers (Basel) 2025; 17:1422. [PMID: 40361349 PMCID: PMC12071057 DOI: 10.3390/cancers17091422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2025] [Revised: 04/21/2025] [Accepted: 04/22/2025] [Indexed: 05/15/2025] Open
Abstract
The molecular landscape of cutaneous melanoma is complex and heterogeneous, and a deeper understanding of the genesis and progression of the tumor driven by genetic alterations is essential for the development of effective diagnostic and therapeutic strategies. Molecular diagnostics and the use of biomarkers are increasingly playing a role in treatment decisions. However, further research is urgently needed to elucidate the relationships between complex genetic alterations and the effectiveness of target therapies (although BRAF mutation is still the only targeted genetic alteration). Further research is required to exploit other targetable genetic alterations such as NRAS, KIT or rare mutations. Treatment guidelines for cutaneous melanoma are continually evolving based on data from recent and ongoing clinical trials. These advancements reflect changes mainly in the optimal timing of systemic therapy and the choice of combination therapies increasingly tailored to molecular profiles of individual tumors. Mono- or combination immunotherapies demonstrated unprecedented success of melanoma treatment; still, there is room for improvement: though several factors of primary or acquired resistance are known, they are not part of patient management as biomarkers. The novel developments of cancer vaccines to treat melanoma (melanoma-marker-based or personalized neoantigen-based) are encouraging; introduction of them into clinical practice without proper biomarkers would be the same mistake made in the case of first-generation immunotherapies.
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Affiliation(s)
- Imre Lőrinc Szabó
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.L.S.); (G.E.)
- HUN-REN-UD Allergology Research Group, University of Debrecen, 4032 Debrecen, Hungary
| | - Gabriella Emri
- Department of Dermatology, MTA Centre of Excellence, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.L.S.); (G.E.)
- HUN-REN-UD Allergology Research Group, University of Debrecen, 4032 Debrecen, Hungary
| | - Andrea Ladányi
- Department of Surgical and Molecular Pathology, National Institute of Oncology, 1122 Budapest, Hungary;
- National Tumor Biology Laboratory, National Institute of Oncology, 1122 Budapest, Hungary
| | - József Tímár
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, 1091 Budapest, Hungary
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Seedor RS, Aplin AE, Bertolotto C, Carvajal RD, Deacon N, Doble K, Hamid O, Haq R, Kadosh M, Khan S, Kraska J, Lutzky J, McKean M, Montazeri K, Moser J, Onken M, Orloff M, Sacco JJ, Smalley K, Selig SM. Meeting Report From the 2023 Cure Ocular Melanoma (CURE OM) Global Science Meeting, Philadelphia, PA, November 2023. Pigment Cell Melanoma Res 2025; 38:e13205. [PMID: 39385554 PMCID: PMC11967437 DOI: 10.1111/pcmr.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 09/02/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024]
Abstract
The 2023 Cure Ocular Melanoma (CURE OM) Global Science Meeting was held in Philadelphia on November 6, 2023. There is increased awareness and dedicated research in uveal melanoma (UM), but unmet needs remain in the prevention, detection, and treatment of UM. The purpose of this meeting was to provide an international forum for the exchange of research ideas, to allow for discussion of basic science as well as clinical research on UM, and to gather input about advocacy and patient needs.
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Affiliation(s)
- Rino S. Seedor
- Sidney Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Andrew E. Aplin
- Sidney Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | | | | | - Omid Hamid
- The Angeles Clinic and Research Institute, a Cedars‐Sinai AffiliateLos AngelesCaliforniaUSA
| | - Rizwan Haq
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Miriam Kadosh
- Melanoma Research Foundation, CURE OMWashingtonDCUSA
| | - Shaheer Khan
- Northwell Health Cancer InstituteNew Hyde ParkNew YorkUSA
| | | | - Jose Lutzky
- Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | | | | | - Justin Moser
- HonorHealth Research InstituteScottsdaleArizonaUSA
| | - Michael Onken
- Washington University in St. LouisSt. LouisMissouriUSA
| | - Marlana Orloff
- Sidney Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | | | | | - Sara M. Selig
- Melanoma Research Foundation, CURE OMWashingtonDCUSA
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Coupland SE, Sonntag SR, Heimann H, Grisanti S. [The concept of the liquid biopsy in the treatment of malignant eye tumours]. DIE OPHTHALMOLOGIE 2024; 121:946-953. [PMID: 39516408 DOI: 10.1007/s00347-024-02132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/05/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024]
Abstract
The liquid biopsy is a cutting-edge technique that involves analysing non-solid biological tissues, primarily blood but also ocular fluids, for the presence of cancer cells or fragments of tumour DNA. Unlike traditional biopsies, liquid biopsies are usually minimally invasive and can be performed more frequently, enabling continuous monitoring of disease progression and treatment efficacy. This article (and the associated series of articles) outlines the key developments in liquid biopsy, which include the analysis of circulating tumor DNA (ctDNA), circulating tumor cells (CTC) and exosomal RNA and protein biomarkers. Techniques, such as digital droplet PCR and next-generation sequencing (NGS) have made it possible to detect even very low levels of ctDNA, which is crucial for early cancer detection and monitoring minimal residual disease. The detection of rare CTCs is enhanced by techniques, such as microfluidic devices and immunomagnetic separation. Multiomic approaches, whereby exosomal RNA, protein and ctDNA analyses are combined, help to create a more comprehensive picture of tumour biology, including insights into tumour heterogeneity, potentially leading to better diagnostic and prognostic tools and helping to predict treatment response and resistance. The challenges of liquid biopsy application, which will be described in the following article, include (a) standardization, (b) cost and accessibility, (c) validation and clinical utility. However, the liquid biopsy represents a promising frontier in the application of precision ocular oncology, with ongoing research likely to expand its applications and improve its effectiveness in the coming years.
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Affiliation(s)
- Sarah E Coupland
- Liverpool Ocular Oncology Research Group, Department of Eye and Vision Science, University of Liverpool, 3rd Floor, William Henry Duncan Building, 6 West Derby Street, L7 8TX, Liverpool, Großbritannien.
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien.
| | - Svenja R Sonntag
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Luebeck, Deutschland
| | - Heinrich Heimann
- Liverpool Ocular Oncology Research Group, Department of Eye and Vision Science, University of Liverpool, 3rd Floor, William Henry Duncan Building, 6 West Derby Street, L7 8TX, Liverpool, Großbritannien
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Foundation Trust, Liverpool, Großbritannien
| | - Salvatore Grisanti
- Department of Ophthalmology, University Medical Center Schleswig-Holstein, Luebeck, Deutschland
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Varela M, Villatoro S, Lorenzo D, Piulats JM, Caminal JM. Optimizing ctDNA: An Updated Review of a Promising Clinical Tool for the Management of Uveal Melanoma. Cancers (Basel) 2024; 16:3053. [PMID: 39272911 PMCID: PMC11394595 DOI: 10.3390/cancers16173053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Uveal melanoma (UM) is the most common primary malignant intraocular tumor in adults. Distant metastasis is common, affecting around 50% of patients. Prognostic accuracy relies on molecular characterization of tumor tissue. In these patients, however, conventional biopsy can be challenging due to the difficulty of obtaining sufficient tissue for the analysis due to the small tumor size and/or post-brachytherapy shrinkage. An alternative approach is liquid biopsy, a non-invasive technique that allows for real-time monitoring of tumor dynamics. Liquid biopsy plays an increasingly prominent role in precision medicine, providing valuable information on the molecular profile of the tumor and treatment response. Liquid biopsy can facilitate early detection and can be used to monitor progression and recurrence. ctDNA-based tests are particularly promising due to their ease of integration into clinical practice. In this review, we discuss the application of ctDNA in liquid biopsies for UM. More specifically, we explore the emerging technologies in this field and the advantages and disadvantages of using different bodily fluids for liquid biopsy. Finally, we discuss the current barriers to routine clinical use of this technique.
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Affiliation(s)
- Mar Varela
- Department of Pathology, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Laboratori Core d'Anàlisi Molecular, Hospital Universitari de Bellvitge-Institut Català d'Oncologia, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Villatoro
- Department of Pathology, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Laboratori Core d'Anàlisi Molecular, Hospital Universitari de Bellvitge-Institut Català d'Oncologia, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Lorenzo
- Ophthalmology Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Piulats
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Medical Oncology Department, Institut Català d'Oncologia, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Maria Caminal
- Ophthalmology Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
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