A 20-Year Real-World Benchmark of Metastatic Uveal Melanoma Outcomes in a Tebentafusp-Inaccessible Setting: A Comprehensive Cancer Center Study

Background: Uveal melanoma (UM) is a rare malignancy. Despite effective local control, 10–50% of patients develop metastatic disease, which is associated with poor prognosis. Real-world data remain lacking. This study evaluated the clinical characteristics, treatment patterns, and survival outcomes of metastatic UM in a comprehensive cancer center in Jordan. Methods: This retrospective study included adult patients with metastatic UM treated and followed at King Hussein Cancer Center in Jordan (2006–2025). Baseline characteristics and treatment patterns were collected. Descriptive and inferential statistical analyses were performed in JASP v0.95.4 and R v4.5.3. A two-sided p < 0.05 was considered statistically significant. Results: Among 125 patients with followed UM, 31 (24.8%) had metastatic disease and were included in the analysis. Median age at diagnosis was 51 years, 61.3% were males, 61.2% had an ECOG PS 0–1, and 51.6% had hepatic-only metastases. Median time to distant metastasis was 25 months. Median OS from initial diagnosis was 35 months, while median post-metastatic OS (PM-OS) was 10 months. First-line immunotherapy was associated with improved PM-OS compared to Dacarbazine (median, 11 vs. 5 months; p = 0.034; 24-month PM-OS, 44.4% vs. 0%). In exploratory analysis, patients who continued immunotherapy beyond radiologic progression, consistent with pseudoprogression, had longer PM-OS than those who discontinued therapy (median, 32 vs. 6 months; Log-rank p = 0.020). Conclusions: In this real-world cohort, metastatic UM was associated with poor outcomes and limited access to novel therapies including Tebentafusp. First-line immunotherapy may be associated with favorable survival outcomes, and hypothesis-generating exploratory analysis suggested potential benefit from immunotherapy continuation beyond radiologic progression.