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   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 12  |  Page : 1964

Commentary: Prognostication of uveal melanoma based on molecular diagnosis - Are we there yet?


Department of Ocular Oncology and Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Web Publication22-Nov-2019

Correspondence Address:
Vikas Khetan
Department of Ocular Oncology and Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1899_19

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How to cite this article:
Attiku Y, Khetan V. Commentary: Prognostication of uveal melanoma based on molecular diagnosis - Are we there yet?. Indian J Ophthalmol 2019;67:1964

How to cite this URL:
Attiku Y, Khetan V. Commentary: Prognostication of uveal melanoma based on molecular diagnosis - Are we there yet?. Indian J Ophthalmol [serial online] 2019 [cited 2019 Dec 15];67:1964. Available from: http://www.ijo.in/text.asp?2019/67/12/1964/271369



In their review on the cancer genome  Atlas More Details classification (TGCA), Shields et al. have diligently explained how this new classification system will help in prognostication of the disease, over the American Joint Committee on Cancer (AJCC) classification.[1] The TGCA is an accomplished program started in 2005 to elaborate the molecular genomics of few cancers.[2] It was later on expanded to include several other cancers including uveal melanoma (UM).[3]

The tissue obtained with fine-needle aspiration biopsy was subjected to molecular testing. The UM were divided into four categories: A, B, C, and D based on the presence or absence of chromosome 3 disomy and then further based on the presence and degree of chromosome 8q gain.[3],[4] Category D had the worst prognosis with high rates of metastasis and cancer-related deaths.[3] By prognostication of the disease, the patient can be counseled regarding the nature of the disease. The frequency of follow-up also can be individualized. Chemotherapeutic drugs targeting these genetic variations or their genetic products are being explored and may be available in the near future.[5]

Though it is a landmark program, currently molecular diagnostics may not be economical in developing countries such as India where resources for cancer treatment are limited. Hence, we will have to continue to rely on the AJCC classification, which is a clinical classification. The genetic variation in UM in Indian patients may be different from that tested in TGCA.

Also, there is no treatment at hand targeting the disease at its molecular level. In the Indian scenario, only predicting the outcome of the disease with no change in treatment strategy may not be an alluring diagnostic test for the patient. The real-world benefit of this classification system is yet to be proved.



 
  References Top

1.
Shields CL, Dalvin LA, Vichitvejpaisal P, Mazloumi M, Ganguly A, Shields JA. Prognostication of uveal melanoma is simple and highly predictive using The Cancer Genome Atlas (TCGA) classification: A review. Indian J Ophthalmol 2019;67:1959-63.  Back to cited text no. 1
  [Full text]  
2.
Tomczak K, Czerwińska P, Wiznerowicz M. The cancer genome atlas (TCGA): An immeasurable source of knowledge. Contemp Oncol 2015;19:A68-77.  Back to cited text no. 2
    
3.
Jager MJ, Brouwer NJ, Esmaeli B. The cancer genome atlas project: An integrated molecular view of uveal melanoma. Ophthalmology 2018;125:1139-42.  Back to cited text no. 3
    
4.
Robertson AG, Shih J, Yau C, Gibb EA, Oba J, Mungall KL, et al. Integrative analysis identifies four molecular and clinical subsets in uveal melanoma. Cancer Cell 2017;32:204-20.  Back to cited text no. 4
    
5.
Croce M, Ferrini S, Pfeffer U, Gangemi R. Targeted therapy of uveal melanoma: Recent failures and new perspectives. Cancers 2019;11:E846.  Back to cited text no. 5
    




 

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