What is your approach to metastatic choroidal melanoma with systemic metastases outside of a clinical trial?

I often consider local therapy for systemic mets with radiation (Mostly SBRT), embolization, ablation, Y-90 etc. In very selected patients surgery. If widespread disease or not a candidate for local therapy then I favor PD-1 inhibitors over ipi to start due to toxicity. Both agents have limited acti...