New approach offers hope for people with rare eye cancer

A more active approach to monitoring and treating people with a rare eye cancer (known as uveal melanoma) that has spread to the liver could help some patients to live longer, according to researchers at Barts Cancer Institute, Queen Mary University of London. The findings, from a retrospective study of the largest UK cohort of patients with this condition to date, offer an encouraging sign of progress in this rare and difficult-to-treat cancer.

Uveal melanoma is a rare type of eye cancer with around 600-700 new cases each year in the UK. When the disease spreads to the liver, treatment options are limited, and most people live less than two years. Because it is so rare, large clinical trials are difficult to carry out, giving doctors little evidence to guide care.

In this new study, published in Annals of Surgery Open, Professor Hemant Kocher and colleagues looked back at the records of 58 people treated between 2010 and 2024 at Barts Health NHS Trust and The London Clinic. The team wanted to see whether careful monitoring and more active removal of metastases were associated with longer survival.

People whose cancer had spread to only a few small areas of the liver were offered surgery or a heat-based technique called ablation to remove or destroy the tumours, along with chemotherapy or immunotherapy where appropriate. They were then followed up closely so that, if the cancer returned, new spots could be treated straight away.

Those who received the combined approach lived a median of 45 months after their liver treatment – nearly four years, where median survival for this condition is usually less than two years. A few patients who received the new approach have now lived eight to ten years after treatment, an outcome rarely seen for this cancer.

One patient, Margaret, is alive today, 13 years after her original diagnosis in 2012. She comments: “I’m eternally grateful that Professor Kocher has given me all of these extra years to enjoy with my loved ones.” (See ‘Margaret’s Story’ below).

Professor Hemant Kocher

The study’s survival results also compare favourably with those seen in recent immunotherapy trials for this disease, suggesting that surgery or ablation may have an important role alongside drug treatments

Professor Kocher said: “By adapting what we’ve learned from more common cancers such as bowel cancer, we’ve shown that some people with uveal melanoma could benefit from active and repeated treatment when the cancer is found early in the liver.”

The researchers stress that this was a small, retrospective study rather than a clinical trial, so further research is needed to confirm the results and fully understand the factors contributing to the longer survival in these patients. They now seek to carry out larger, prospective studies and to explore the biology behind these differences.

“Although our findings need to be tested in future studies, they show that people with this rare cancer do have options and reasons for hope,” Professor Kocher added.

“Patients with metastatic uveal melanoma need more treatment options,” noted Dr Marc Hurlbert, CEO of Melanoma Research Alliance. “Professor Kocher and his colleagues present an interesting retrospective case series on the impact of intensive surveillance for oligometastatic liver disease and the impact of surgical resection/ablation and systemic treatment on long-term remission in some cases. We look forward to additional institutions reporting their experiences and to future prospective trials and validation in multi-centre cohorts across the globe.”

The work involved collaborators from Barts Health NHS Trust, The London Clinic and Moorfields Eye Hospital. Researchers were supported by grants from The London Clinic, Pancreatic Cancer Research Fund and the NIHR Barts Biomedical Research Centre.

Margaret’s Story

Margaret is one of the patients included in the new study published by Professor Kocher and his team. Her story began in June 2012, when she told her optician that she had been seeing what looked like a hair in her vision that she couldn’t seem to brush away. After further tests, she was referred to Moorfields Eye Hospital and was diagnosed with stage 4 uveal melanoma.

“I was told a tumour had been found, and it was too large for any option other than to remove my eye. I was absolutely stunned. Everything had happened so quickly,” Margaret explains. “Within 10 days of mentioning the hairline issue at my opticians, I had surgery booked at St Bartholomew’s Hospital to remove my eye.”

The surgery was successful, but Margaret was also warned that there was a risk the cancer could spread to her liver.

“I went for regular ultrasounds at my local hospital and everything was going well. Until they found something in my liver. Immediately, I knew I needed to be in the right hands. I knew the cancer was rare and information about it was limited, so I needed specialists,” says Margaret.

After expressing this to her surgeon, Margaret was referred to Professor Peter Szlosarek, Professor of Medical Oncology at Barts Cancer Institute, Queen Mary University of London, and a specialist oncologist working in London and the East of England.

Margaret worked closely with her medical team to make informed decisions that reflected what mattered most to her. Professor Szlosarek outlined her options, including immunotherapy or liver surgery.

“I knew immunotherapy could have side effects, so I decided to enquire about the possibility of surgery,” says Margaret.

Professor Szlosarek therefore recommended Margaret meet with Professor Kocher.

Margaret, enjoying the extra years of health that her treatment has given her.

“I met Professor Kocher and instantly knew I was in capable, safe hands. His team was fantastic, and I had complete faith in them. I can’t praise him enough,” says Margaret. “He empathetically considers any underlying concerns and needs I may have and then, after considered discussions, we come up with our joint action plan and I know the final decision is the right one for me. I wanted a top doctor who would listen, in a top location with excellent nurses, and that’s exactly what I got!”

Margaret underwent surgery to remove part of her liver in January 2016 and then received regular MRI and PET/CT scans every six months to monitor her liver’s health. When the team detected another tumour in her liver in April 2021, Margaret again decided to have surgery to remove the tumour.

Margaret has lived with her cancer now for more than 13 years since her original diagnosis, and is still receiving regular scans. She says that she is proud to have contributed to Professor Kocher’s retrospective study of the largest UK cohort of uveal melanoma patients.