Did a patient with uveal melanoma benefit from combined tebentafusp and SBRT?
A single case report describes a 39-year-old woman with metastatic uveal melanoma who benefited from combining tebentafusp with stereotactic body radiotherapy (SBRT). After initial progression in a lymph node while on tebentafusp alone, she received SBRT to that site while continuing tebentafusp. She then achieved a partial response across all lesions and maintained disease control for an additional 35 months with excellent quality of life 2. This is one patient's experience, not a large study, but it suggests the combination may be beneficial in selected cases.
What the research says
Tebentafusp is an approved treatment for HLA-A*02:01-positive patients with metastatic uveal melanoma. A phase 3 trial showed it improves overall survival compared to investigator's choice therapy, with median survival of 21.6 months versus 16.9 months and 27% of patients alive at 3 years 5. A network meta-analysis found that liver-directed therapy combined with immune checkpoint inhibitors was the most effective approach for liver metastatic uveal melanoma, with tebentafusp showing the second-best overall survival but the worst progression-free survival among compared treatments 1.
Radiotherapy, including SBRT, can induce immunogenic cell death and may enhance antitumor immune responses when combined with immunotherapies like tebentafusp 2. The case report describes a patient who had oligoprogression (progression in only one site) while on tebentafusp; after adding SBRT to that site, she achieved a partial response and durable disease control 2. This suggests that combining local radiotherapy with tebentafusp may overcome resistance in some patients.
Other liver-directed therapies, such as immunoembolization, have shown disease control rates in liver-dominant metastatic uveal melanoma, but outcomes vary 3. The phase 2 trial of tebentafusp (IMCgp100) established its efficacy in the first-line setting 4. A propensity score-weighted analysis comparing tebentafusp to nivolumab plus ipilimumab suggested tebentafusp may offer better overall survival 6. Research also indicates that tebentafusp can reprogram macrophages in the tumor microenvironment, and combining it with IL-2 may enhance benefit in patients with high levels of tumor-associated macrophages 7.
What to ask your doctor
- Am I HLA-A*02:01 positive, and is tebentafusp an option for my metastatic uveal melanoma?
- If I have oligoprogression while on tebentafusp, could adding SBRT to the progressing site be considered?
- What are the potential benefits and risks of combining radiotherapy with tebentafusp in my case?
- Are there clinical trials or published cases of combined tebentafusp and SBRT that might guide my treatment?
- How does my tumor burden and location (liver vs. other sites) affect the choice between tebentafusp alone or with liver-directed therapy?
This question is drawn from common patient questions about Oncology and answered using cited medical research. We do not provide individualized advice.