Treatments for eye cancer that have spread

Liver surgery

Sometimes, it is possible to remove part of the liver where the cancer is. This surgery is called a liver resection. Different factors affect whether liver resection is an option. Your medical team will talk to you about this.

Chemosaturation

If surgery is not an option, you may receive chemotherapy directly to the liver. Doctors can isolate the liver from the rest of the body’s blood circulation to deliver strong chemotherapy to treat the cancer. 

This treatment has a number of names, including hepatic arterial infusion of chemotherapy, hepatic chemosaturation, chemosaturation therapy, and percutaneous hepatic perfusion (PHP). You may also hear the brand names Chemostat or Delcath.

Currently, this treatment is only available privately in the UK. 

NHS England is currently reviewing whether it should be available on the NHS for people with ocular melanoma. Your medical team will be able to tell you more about this.

Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) uses heat to kill cancer cells. Radio waves are a type of energy that can be used to heat up tissues inside the body. When they are focused on cancer cells, they can kill them.

Microwave ablation (MWA)

Microwave ablation (MWA) uses microwave energy instead of radio frequency energy. Surgeons use it to heat the liver and damage cancer cells.

Radioembolisation

This treatment involves injecting tiny, microscopic radioactive beads called microspheres into your liver. The beads lodge themselves in the tiny blood vessels surrounding the tumours in the liver. They give off high doses of radiation that shrink the tumours. 

Doctors also call this treatment selective internal radiotherapy or use the brand name SIR-spheres.

Hepatic Artery Embolisation (HAE) or Hepatic Artery Chemo-Embolisation (HAC)

Hepatic artery embolisation (HAE) uses microscopic gel beads to block off the blood vessels feeding tumours inside the liver. 

Hepatic artery chemo-embolisation (HAC) combines chemotherapy and hepatic artery embolisation, by soaking the embolisation beads in a strong chemotherapy solution. It is also known as HAC and TACE (transarterial chemo-embolisation).

Adjuvant therapies

It is common for conjunctival melanomas to spread in and around the eye. If surgery is not required, most patients receive cryotherapy, radiation or topical chemotherapy. 

Some patients with conjunctival melanoma will receive cryotherapy, radiation therapy or topical chemotherapy (like eye drops) in addition to surgery. This is to prevent the cancer from coming back.

Surgery for metastasis

Conjunctival melanomas often spread to the lungs, brain, liver, skin, bone and gut. However, spread can happen anywhere in the body. 

Depending on where your conjunctival melanoma spreads, you may be offered surgery to remove the tumours.

Orbital exenteration

Large conjunctival melanomas can sometimes spread locally into the eyelids and other areas around the eye. For these patients, the eye and surrounding tissue may need to be removed. This surgery is called orbital exenteration.

This type of surgery is rarely needed.

Targeted therapies

Around half of people living with conjunctival melanoma have a mutation in the BRAF gene, which is related to cancer growth. 

If your cancer is found to be “BRAF positive”, you may be given Dabrafenib or Vemurafenib to treat metastatic conjunctival melanoma. 

Because conjunctival melanoma is rare, it is not known how patients have benefitted from these treatments.

Checkpoint Inhibitors

Checkpoint inhibitors work by helping the immune system attack cancer cells. For ocular melanomas, you will receive an intravenous drip (infusion) of drugs like ipilimumab, nivolumab and pembrolizumab. 

Read more about checkpoint inhibitors on Macmillan Cancer Support’s page.

Tebentafusp

Tebentafusp is an anti-cancer medication that is given through a drip (infusion). You might also hear it called KIMMTRAK or IMCgp100.

To qualify for this treatment, you must test positive for certain HLA (Human Leukocyte Antigen) markers in genes involving your immune system. A blood test can confirm if you are HLA-A*02:01-positive.

Other types of immunotherapy

TILs and CAR-T are related therapy approaches. In both cases, immune cells are harvested and grown outside the body and then returned to the patient as a cancer treatment.

In TILs, these cells are the patients’ own unmodified cells. In CAR-T, these cells are genetically modified and may come from a donor. 

Not enough evidence is currently available to suggest these treatments could help people with ocular melanoma. The NHS does not currently fund these.

Dacarbazine

You may be given Dacarbazine (or DITC) to treat metastatic melanoma (of the skin). Doctors do not know how this treatment works for patients with ocular melanomas. 

If you are offered Dacarbazine, your medical team will provide more information about this treatment.