How do you approach patients with metastatic uveal melanoma not a candidate for tebentafusp-tebn? 

I perform genomics and try to find a clinical trial that fits the patient. Including local liver therapies, such as the Delcath catheter treatment if available. Isolated liver lesion could also be resectable, so I request a surgical opinion. If nothing is available, then I offer ipilimumab/nivolumab...

I highly recommend participation in clinical trials, as there are some promising agents in development in this case, such as Ideaya Bio's targeted therapy against PKC (darovasertib/IDE196+ crizotinib, Darovasertib Plus Crizotinib Shows Early Promise in Metastatic Uveal Melanoma (onclive.com).

Toxicit...