Visual Acuity Improved With Prophylactic Bevacizumab for Uveal Melanoma
Results from a cohort study of patients with irradiated uveal melanoma suggest that prophylactic intravitreal bevacizumab may be tied to improved visual outcomes up to 4 years (JAMA Ophthalmol. 2019 Dec 12. Epub ahead of print).
“Radiation retinopathy following plaque radiotherapy for uveal melanoma can lead to vision loss that might be avoided with prophylactic anti–vascular endothelial growth factor treatment,” said Carol L. Shields, MD, Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, and colleagues, who sought to evaluate the visual outcomes of patients with plaque-irradiated uveal melanoma given prophylactic intravitreal bevacizumab.
Thus, Dr Shields et al conducted a retrospective, nonrandomized, interventional trial comparing 1131 eyes given prophylactic bevacizumab between 2008 and 2018 (bevacizumab arm) with 117 eyes with irradiated uveal melanoma not given the prophylactic between 2007 and 2009 (control arm).
Patients (median age, 61 years) had median tumor thickness and median distance to foveola of 4.0 mm and 3.0 mm, respectively. They were given intravitreal bevacizumab prophylaxis at the time of plaque removal and at 4-month intervals over 2 years (mean follow-up, 40 months with bevacizumab and 56 months without bevacizumab; mean difference, −18; 95% CI, −24 to −13; P <.001).
There were no differences observed between the cohorts vis-à-vis demographic features, clinical characteristics, or radiation parameters, and the investigators pursued a main outcome of visual acuity.
In the bevacizumab arm versus control arm, survival analysis revealed less optical coherence tomography evidence of cystoid macular edema at 24 months (28% vs 37%, respectively; hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P = .02) and 36 months (44% vs 54%, respectively; HR, 1.5; 95% CI, 1.1-2.1; P = .01). In addition, survival analysis showed less clinical evidence of radiation maculopathy at 24 months (27% vs 36%, respectively; HR, 1.5; 95% CI, 1.0-2.2; P = .03), 36 months (44% vs 55%, respectively; HR, 1.50; 95% CI, 1.1-2.0; P = .01), and 48 months (61% vs 66%, respectively; HR, 1.4; 95% CI, 1.0-1.9; P = .03) and less clinical evidence of radiation papillopathy at 18 months (6% vs 12%; HR, 2.0; 95% CI, 1.1-3.9; P = .04).
Better visual acuity outcomes were observed in the bevacizumab arm versus control arm at all points via nonparametric analysis, including at 12 months (median logMAR visual acuity [Snellen equivalent]: 0.30 [20/40] vs 0.48 [20/60], respectively; mean difference, −0.28; 95% CI, −0.48 to −0.07; P = .02), 24 months (0.40 [20/50] vs 0.70 [20/100], respectively; mean difference, −0.52; 95% CI, −0.75 to −0.29; P <.001), 36 months (0.48 [20/60] vs 1.00 [20/200], respectively; mean difference, −0.49; 95% CI, −0.76 to −0.21; P = .003), and 48 months (0.54 [20/70] vs 2.00 [counting fingers], respectively; mean difference, −0.71; 95% CI, −1.03 to −0.38; P <.001).
“These findings from a retrospective cohort of plaque radiotherapy and prophylactic intravitreal bevacizumab in patients with uveal melanoma suggest better visual outcomes when compared with nonrandomized historical control individuals through 4 years,” Dr Shields and colleagues concluded.—Hina Porcelli
