OBJECTIVES: Uveal melanoma, a primary intraocular cancer originating from melanocytes, can invade locally and metastasize. Treatment advances in eye plaque brachytherapy (EPBT) and immunotherapy aim to improve outcomes and preserve vision. This systematic review analyses current treatment patterns in uveal melanoma patients.

METHODS: We systematically searched Embase^® and MEDLINE^® databases via Embase.com to identify English-language articles, published after 2010, reporting real-world treatment pattern data for uveal melanoma in adults. Clinical practice guidelines (CPGs) were identified through grey literature searches.

RESULTS: Out of 1,032 studies screened, nine real-world articles and five CPGs were included in this review. Two guidelines were from the USA, and one each from Europe, Canada, and the UK. Guidelines highlight EPBT for small and medium uveal melanoma, expanding its use for larger tumours. Systemic therapies like pembrolizumab or nivolumab are recommended as the disease progresses, with nivolumab and ipilimumab as a third-line treatment option. Real-world evidence from the National Cancer Database (NCDB) shows a shift from enucleation to EPBT for small to medium tumours, with EPBT use for large tumours increasing from 30% in 2004 to 45% in 2015. A study across 40 centres in Austria, Germany, and Switzerland found that nearly 80% of centres preferred a combination of nivolumab and ipilimumab for metastatic or advanced disease. Nivolumab and ipilimumab monotherapies were used in 42.5% and 40% of centres, respectively. National Comprehensive Cancer Network (NCCN) guidelines also propose proton therapy, stereotactic radiosurgery (SRS), and globe-preserving surgeries, with personalized treatment plans based on tumour size, location, and patient preferences.

CONCLUSIONS: CPGs recommend EPBT as the first-line treatment for uveal melanoma, followed by pembrolizumab or nivolumab. While real-world treatments are concordant with CPGs for first-line treatment, adherence to recommendations for subsequent lines varies due to socio-economic and demographic factors.