Uveal melanoma: the decisions you may face

Cancer page →Second-opinion finder →

4 treatment settings, 2 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Primary tumour

2 options

Plaque brachytherapy (I-125 or Ru-106) or proton beam radiotherapy for most; enucleation for large tumours; prognostic biopsy for GEP/chromosome 3.

Guideline

NCCN · Category 2A

The options, in plain words

BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

Highest conformality
Short treatment

Proton therapyEstablished

Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose.

No exit dose; lower integral dose
Reduced second cancers in children

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Brachytherapy

Invasive
Declining expertise in some regions

Proton therapy

Cost
Range uncertainty
Limited randomised evidence in adults

Questions to ask about this decision

Between Brachytherapy and Proton therapy, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Uveal Melanoma), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (primary tumour), which of the standard options do you recommend and why?
Why: Guideline options include: Plaque brachytherapy (I-125 or Ru-106) or proton beam radiotherapy for most; enucleation for large tumours; prognostic biopsy for GEP/chromosome 3.

Add these to your appointment list, or take the full question set for this cancer.

Screening, prevention and diagnosis

Surveillance

One path named

Risk-adapted liver imaging (MRI/ultrasound) every 6-12 months for high-risk GEP class 2 / monosomy 3; no proven adjuvant therapy.

The path, in plain words

MRIStandard of care

MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.

No ionising radiation
Best soft-tissue and brain imaging
Functional sequences (diffusion, perfusion)

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

MRI

Slow and expensive
Motion artefacts
Gadolinium concerns in renal impairment

Questions to ask about this decision

Is MRI the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (surveillance), which of the standard options do you recommend and why?
Why: Guideline options include: Risk-adapted liver imaging (MRI/ultrasound) every 6-12 months for high-risk GEP class 2 / monosomy 3; no proven adjuvant therapy.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, HLA-A*02:01-positive

One path named

Tebentafusp weekly (OS 21.7 vs 16.0 months vs investigator's choice); manage cytokine release and rash.

Guideline

NCCN · Category 1ESMO-MCBS · 4

The path, in plain words

TebentafuspApprovedImmTAC (TCR×CD3 bispecific)

The first drug to improve survival in metastatic uveal melanoma, and the first TCR-based bispecific.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision

Is Tebentafusp the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Uveal Melanoma), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (metastatic, hla-a*02:01-positive), which of the standard options do you recommend and why?
Why: Guideline options include: Tebentafusp weekly (OS 21.7 vs 16.0 months vs investigator's choice); manage cytokine release and rash.
Am I a candidate for Tebentafusp, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, HLA-A*02:01-negative or liver-dominant

5 optionsCompare side by side →

Percutaneous hepatic perfusion with melphalan (FOCUS trial; approved 2023), radioembolisation, hepatic resection; ipilimumab-nivolumab (~15% response); clinical trials (darovasertib-crizotinib).

The options, in plain words

Percutaneous hepatic perfusion (chemosaturation)Approved

Isolating the liver's circulation with catheters and balloons so that high-dose melphalan can be pumped through it and filtered out before it reaches the rest of the body; approved in 2023 for eye melanoma that has spread to the liver.

Randomised/pivotal evidence in a disease with few options
Repeatable (up to 6 cycles)
Treats the whole liver, including occult disease

Melphalan (including hepatic delivery system)ApprovedAlkylating agent (nitrogen mustard)

The myeloma chemotherapy that is also the standard high-dose conditioning before autologous transplant, and, delivered directly into the liver's blood supply or the eye, treats uveal melanoma metastases and retinoblastoma.

Radioembolisation (TARE / SIRT, yttrium-90)Established

Millions of tiny radioactive glass or resin beads are injected into the liver artery, lodging in the tumour and irradiating it from within.

Outpatient, single session
Effective in portal vein thrombosis where TACE is contraindicated
Radiation segmentectomy can be curative for small tumours

IpilimumabApprovedMonoclonal antibody (anti-CTLA-4)

Ipilimumab was the first checkpoint inhibitor (2011), and proved the immune system could be unleashed against cancer.

NivolumabApprovedMonoclonal antibody (anti-PD-1)

Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Percutaneous hepatic perfusion (chemosaturation)

Myelosuppression despite filtration; bleeding, hepatic injury
Requires specialised interventional radiology and anaesthesia
Liver-only benefit; extrahepatic disease progresses

Radioembolisation (TARE / SIRT, yttrium-90)

Radioembolisation-induced liver disease
Failed to beat sorafenib on OS in advanced disease
Lung shunting excludes some patients

Ipilimumab all recorded rates →

Side effect	Any grade	Grade 3+
Colitis (with nivolumab 1+3) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	25%	14.4%
Hepatitis (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	15%	13.4%
Rash (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	28%	4.8%
Adrenal insufficiency (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	8%	2.6%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Nivolumab all recorded rates →

Side effect	Any grade	Grade 3+
Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated	25%	14.4%
Hepatitis with ipilimumab · Monotherapy pooled unless stated	15%	13.4%
Colitis · Monotherapy pooled unless stated	2.9%	1.7%
Hepatitis · Monotherapy pooled unless stated	1.8%	1.5%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision

Between Percutaneous hepatic perfusion (chemosaturation), Melphalan (including hepatic delivery system), Radioembolisation (TARE / SIRT, yttrium-90) and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
Which side effects of Ipilimumab or Nivolumab are most likely for me, which are reversible, and which would make us stop?
Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (metastatic, hla-a*02:01-negative or liver-dominant), which of the standard options do you recommend and why?
Why: Guideline options include: Percutaneous hepatic perfusion with melphalan (FOCUS trial; approved 2023), radioembolisation, hepatic resection; ipilimumab-nivolumab (~15% response); clinical trials (darovasertib-crizotinib).
Am I a candidate for Melphalan (including hepatic delivery system), Ipilimumab, Nivolumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.

Living with cancer·Standard of care

Uveal melanoma: the decisions you may face

Cancer page →Second-opinion finder →

Other settings

Primary tumour

2 options

Plaque brachytherapy (I-125 or Ru-106) or proton beam radiotherapy for most; enucleation for large tumours; prognostic biopsy for GEP/chromosome 3.

Guideline

NCCN · Category 2A

The options, in plain words

BrachytherapyStandard of care

Brachytherapy places a radioactive source directly inside or next to the tumour.

Highest conformality
Short treatment

Proton therapyEstablished

Radiation using protons, which stop inside the tumour instead of passing through, so tissue behind it gets no dose.

No exit dose; lower integral dose
Reduced second cancers in children

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Brachytherapy

Invasive
Declining expertise in some regions

Proton therapy

Cost
Range uncertainty
Limited randomised evidence in adults

Questions to ask about this decision

Between Brachytherapy and Proton therapy, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Uveal Melanoma), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (primary tumour), which of the standard options do you recommend and why?
Why: Guideline options include: Plaque brachytherapy (I-125 or Ru-106) or proton beam radiotherapy for most; enucleation for large tumours; prognostic biopsy for GEP/chromosome 3.

Add these to your appointment list, or take the full question set for this cancer.

Screening, prevention and diagnosis

Surveillance

One path named

Risk-adapted liver imaging (MRI/ultrasound) every 6-12 months for high-risk GEP class 2 / monosomy 3; no proven adjuvant therapy.

The path, in plain words

MRIStandard of care

No ionising radiation
Best soft-tissue and brain imaging
Functional sequences (diffusion, perfusion)

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

MRI

Slow and expensive
Motion artefacts
Gadolinium concerns in renal impairment

Questions to ask about this decision

Is MRI the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (surveillance), which of the standard options do you recommend and why?
Why: Guideline options include: Risk-adapted liver imaging (MRI/ultrasound) every 6-12 months for high-risk GEP class 2 / monosomy 3; no proven adjuvant therapy.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, HLA-A*02:01-positive

One path named

Tebentafusp weekly (OS 21.7 vs 16.0 months vs investigator's choice); manage cytokine release and rash.

Guideline

NCCN · Category 1ESMO-MCBS · 4

The path, in plain words

TebentafuspApprovedImmTAC (TCR×CD3 bispecific)

The first drug to improve survival in metastatic uveal melanoma, and the first TCR-based bispecific.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.

Questions to ask about this decision

Is Tebentafusp the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
Does your recommendation follow the current guideline (NCCN Guidelines: Uveal Melanoma), and if it departs from it, why?
Why: Departures from guidelines are sometimes right for an individual; they should be explained.
For my situation (metastatic, hla-a*02:01-positive), which of the standard options do you recommend and why?
Why: Guideline options include: Tebentafusp weekly (OS 21.7 vs 16.0 months vs investigator's choice); manage cytokine release and rash.
Am I a candidate for Tebentafusp, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, HLA-A*02:01-negative or liver-dominant

5 optionsCompare side by side →

Percutaneous hepatic perfusion with melphalan (FOCUS trial; approved 2023), radioembolisation, hepatic resection; ipilimumab-nivolumab (~15% response); clinical trials (darovasertib-crizotinib).

The options, in plain words

Percutaneous hepatic perfusion (chemosaturation)Approved

Randomised/pivotal evidence in a disease with few options
Repeatable (up to 6 cycles)
Treats the whole liver, including occult disease

Melphalan (including hepatic delivery system)ApprovedAlkylating agent (nitrogen mustard)

Radioembolisation (TARE / SIRT, yttrium-90)Established

Millions of tiny radioactive glass or resin beads are injected into the liver artery, lodging in the tumour and irradiating it from within.

Outpatient, single session
Effective in portal vein thrombosis where TACE is contraindicated
Radiation segmentectomy can be curative for small tumours

IpilimumabApprovedMonoclonal antibody (anti-CTLA-4)

Ipilimumab was the first checkpoint inhibitor (2011), and proved the immune system could be unleashed against cancer.

NivolumabApprovedMonoclonal antibody (anti-PD-1)

Nivolumab was the second PD-1 blocker and is often combined with ipilimumab. Long-term data show about half of advanced melanoma patients alive at 10 years on the combination.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Percutaneous hepatic perfusion (chemosaturation)

Myelosuppression despite filtration; bleeding, hepatic injury
Requires specialised interventional radiology and anaesthesia
Liver-only benefit; extrahepatic disease progresses

Radioembolisation (TARE / SIRT, yttrium-90)

Radioembolisation-induced liver disease
Failed to beat sorafenib on OS in advanced disease
Lung shunting excludes some patients

Ipilimumab all recorded rates →

Side effect	Any grade	Grade 3+
Colitis (with nivolumab 1+3) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	25%	14.4%
Hepatitis (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	15%	13.4%
Rash (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	28%	4.8%
Adrenal insufficiency (with nivolumab) · Nivolumab 1 mg/kg + ipilimumab 3 mg/kg, melanoma	8%	2.6%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Nivolumab all recorded rates →

Side effect	Any grade	Grade 3+
Colitis with ipilimumab (1+3 mg/kg) · Monotherapy pooled unless stated	25%	14.4%
Hepatitis with ipilimumab · Monotherapy pooled unless stated	15%	13.4%
Colitis · Monotherapy pooled unless stated	2.9%	1.7%
Hepatitis · Monotherapy pooled unless stated	1.8%	1.5%

Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.

Questions to ask about this decision

Between Percutaneous hepatic perfusion (chemosaturation), Melphalan (including hepatic delivery system), Radioembolisation (TARE / SIRT, yttrium-90) and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
Which side effects of Ipilimumab or Nivolumab are most likely for me, which are reversible, and which would make us stop?
Why: The recorded rates below come from labels and trials; your own risk depends on dose, other medicines and your health.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (metastatic, hla-a*02:01-negative or liver-dominant), which of the standard options do you recommend and why?
Why: Guideline options include: Percutaneous hepatic perfusion with melphalan (FOCUS trial; approved 2023), radioembolisation, hepatic resection; ipilimumab-nivolumab (~15% response); clinical trials (darovasertib-crizotinib).
Am I a candidate for Melphalan (including hepatic delivery system), Ipilimumab, Nivolumab, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.