Download - Ocular melanoma concepts and treatment
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Ocular melanoma and CNAS proteins
Lorenzo Alonso. MD
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Percentages of genetic mutations in melanoma
• BRAF (40-70%)
• RAS: 20%
• PTEN: 20-40%
• C-Kit: acral(36%), mucoses(39%) and chronic sun-damaged skin(28%).
• GNAQ y GNA11: more than 50% in ocular melanoma.
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Iris 3%
Ciliary body 7%
Choroid 90%
GNAS proteins (GNAQ and GNA11).
Blue nevi associated
43% mutation
Sites of ocular melanoma distribution
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The Collaborative Ocular Melanoma Study
• 5 year percentage acumulative metastases: 25%
• 10 year : 34%
• Median overall survival 5 months
• 1-year overall survival: 10-15%
• Metastases distribution: liver, lung(30%), bone(23%), skin (17%).
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Blue nevi: GNAS mutations more than 80%
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Ota nevi
GNAS mutation: 6%
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Proteínas G
Protein
Kinases
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G, GNAS proteins
Locus GNA: q, 11 (GNAS).
Gen that control alpha subunit
Activation
alpha subunit incorporate phosphato
(GDP a GTP) and Beta y Gamma subunit independent
Mutation:
Codon 209
alfaq and alfa11 (GNAQ, GNA11)
disfunction
Metabolic process, growth, intracelular signal, proliferatión
Normal
WellWrong
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.
Krechowec S , Plagge A Physiology 2008;23:221-229
©2008 by American Physiological Society
Proteins GNAS
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Diseases associated with alterated G proteins
Mutations
pseudohypoparathyroidism type 1a, pseudohypoparathyroidism type 1b,
Albright hereditary osteodystrophy, pseudopseudohypoparathyroidism, McCune-Albright syndrome,
progressive osseus heteroplasia, polyostotic fibrous dysplasia of bone, and some pituitary tumors.[1]
Deficiencies:
Albright hereditary osteodystrophy
pseudohypoparathyroidism type Ia
pseudopseudohypoparathyroidism
McCune-Albright syndrome
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GNAS proteins location at the cellular level
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Disseminated ocular melanoma: rationale for a therapeutic
• GNAQ and GNA11 stimulate the MAPK pathway.GNAS proteins are mutated in 80% of ocular melanomas.
• MEK is a key step in the MAPPK pathway.• MEK inhibitor are the logical drugs to be used and they
have been already tested clinically.• Selumetinib, a MEK ½ inhibitor, has been compared with
temozolamide with a significant benefit for Selumetinib in terms of interval free of progression.
• Ipilimumab has shown also activity in metastatic ocular melanoma