Title : A review and comparison of immune checkpoint inhibitors in the treatment of metastatic uveal melanoma
Abstract:
Introduction: Metastatic uveal melanoma (mUM) is a rare, aggressive malignancy with limited responsiveness to conventional chemotherapies. Immune checkpoint inhibitors (ICIs)—including Ipilimumab, pembrolizumab, nivolumab, and dual-agent regimens—have emerged as potential treatment options. Although current evidence often favours dual therapy, detailed comparisons of the efficacy and safety of individual monotherapies remain limited. This meta-analysis evaluates clinical outcomes of single ICI therapies and compares them with dual therapy to support optimal treatment selection for mUM.
Methods: A systematic literature review identified studies reporting objective response rates (ORR), disease control rates (DCR), median progression-free survival (MPFS), and adverse event rates (AER) for Ipilimumab, pembrolizumab, nivolumab, and dual ICI therapy. Data were synthesised using forest plots and analysed to compare therapeutic efficacy and safety.
Results: Dual ICI therapy demonstrated the highest ORR and DCR overall, but these improvements did not reach statistical significance over monotherapies. Dual therapy showed a lower MPFS than pembrolizumab and nivolumab individually. Adverse event rates were substantially higher with dual therapy compared with all single-agent regimens.
Conclusions: Although dual ICI therapy offers improved ORR and DCR in aggregate analyses, monotherapies—particularly pembrolizumab—deliver comparable or superior MPFS with markedly lower toxicity. These findings highlight the importance of personalised treatment planning rather than routine use of dual therapy. Further research is needed to refine clinical guidelines and optimise outcomes for patients with metastatic uveal melanoma.
