Eye cancer is rare and there are different types. It is difficult to do research and carry out trials in a rare type of cancer as there may not be enough people with the same cancer type to join a trial. In this situation, researchers and doctors might organise a trial that recruits people from different countries.
The most common type of eye cancer in adults is uveal melanoma. The uvea is the middle tissue layer of the eyeball. Other types include lymphoma of the eye.
Genes and eye cancer
Researchers in the PROGENOM study are looking at blood and tissue samples taken from people with uveal melanoma. The researchers want to find genes and proteins that behave abnormally in this disease. This information could help doctors in several ways. For example, it could help to predict those people whose cancer is likely to spread. And it could help to develop ideas for new treatments.
Researchers have found that up to half of uveal melanomas have a certain gene change (the loss of one copy of chromosome 3). This means that the cancer is at higher risk of spreading.
Researchers have also found that many uveal melanomas have changes to 2 genes called GNAQ and GNA11. The proteins made by these genes are part of a signalling pathway inside cells, called MEK. This pathway helps cancer cells to grow. Researchers are now looking at drugs that can target proteins in this pathway to try to stop the cancer cells growing.
There is also research looking into genes to find people who are at increased risk of developing eye cancer. They have recently found that a change (mutation) in the BAP1 gene can be passed down (inherited) in some families. This mutation increases the risk of uveal melanoma, melanoma of the skin and some other types of cancer. This is a rare inherited genetic mutation, and only affects a small number of people with eye melanoma.
Targeted cancer drugs
There are many different types of targeted drug. Doctors think that some of these might benefit people with advanced uveal melanoma.
Selumetinib is a type of targeted drug called a MEK inhibitor. MEK is a body protein that sends signals to cells telling them to divide and grow. Blocking MEK may stop cancer cells growing.
In June 2013, a phase 2 American clinical trial found that selumetinib was more successful than temozolomide in treating patients with advanced uveal melanoma. These results are very promising.
In the UK, a phase 2 trial called SelPec is now looking at selumetinib and paclitaxel chemotherapy for advanced uveal melanoma. The research team want to find out if the combination of drugs works better than selumetinib on its own. They also want to find the best way of giving these 2 drugs together.
Trials in America are looking at other targeted drugs for uveal melanoma that has spread. Examples include:
- bevacizumab (Avastin) – a monoclonal antibody that stops the growth of new blood vessels
- vorinostat – a cancer growth blocker
Immunotherapy is a treatment that works by encouraging the immune system to attack cancer cells. A type of immunotherapy are drugs called checkpoint inhibitors. Examples include ipilimumab, nivolumab and pembrolizumab. Trials have shown these drugs to be helpful in some people with melanoma of the skin (cutaneous melanoma). Researchers hope they will also help treat eye melanoma that has spread.
One trial is looking at a new type of immunotherapy for uveal melanoma that has spread. This is called IMCgp100, it works by stimulating certain immune system cells called T cells to find and kill the cancer. Two different trials are recruiting people worldwide, including centres in the UK. People need to test positive for a gene called HLA-A*0201. The trial team check for this by doing a blood test.
Chemotherapy does not generally work well for eye melanoma. Researchers have looked at different combinations of drugs to see if they help eye melanoma that has spread (advanced cancer). For example, trials have looked at gemcitabine, treosulfan, cisplatin and dacarbazine. Although results from early trials were promising, larger trial results have not been as good.
Researchers continue to look at different combinations of chemotherapy drugs alongside targeted drugs. An example is the use of selumetinib with chemotherapy in the SelPac trial.
Treatment into the liver
Uveal melanoma can spread to the liver in some people. If surgery is not an option, it is sometimes possible to have treatment directly into the liver. The doctor puts a small tube (catheter) into the main artery leading to your liver. Then a treatment such as chemotherapy is delivered through the tube into the liver where they treat the cancer.
The FOCUS trial is looking at a treatment called percutaneous hepatic perfusion or chemosaturation. There are 3 main stages to this treatment.
The doctor places 2 small balloons around your liver. This isolates the blood supply of the liver from the rest of the body
The chemotherapy drug is then delivered through a tube into the liver. As the liver is isolated the drug cannot spread to the rest of the body.
A machine called a chemosaturation filter will remove most of the drug from your blood.
You might have up to 6 treatments of chemosaturation in this trial. It is recruiting people from America and Europe, including the UK.
A study looking into the genetics of cancers of the eyelid
One study is collecting tissue samples from people with certain types of skin cancer on or near the eyelid. The study team hope to gain valuable information by looking at the genes in these tissue samples. For example, they want to find out why some people’s cancer continues to grow or comes back after treatment. This information might also help develop new treatments for cancer of the eyelid.
Lymphoma of the eye
There 2 main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Most lymphomas of the eye are NHL and are treated as an NHL. For suitable trials you would need to search our database under your type of lymphoma.
How do I find a clinical trial?
There may not always be a trial that is suitable for you. Unfortunately, there are less trials available for those with a rare type of cancer. Talk to your eye specialist or specialist nurse if you are interested in taking part in a trial. They may know of a trial that is running in your hospital, or another eye specialist hospital.
You can search our clinical trials database. This lists those trials that we are aware of and have permission to include on the site. Use the drop down menu to find eye cancer, or type eye cancer into the search box. If you want to see all the trials, tick the boxes for closed trials and trial results.