Background: Uveal melanoma (UM) is a rare melanoma subset, with distinct biology, genetics, and limited active therapies. Tebentafusp (tebe) has demonstrated a survival advantage however low response rates and a toxicity profile making real-world administration challenging. Methods: Data was retrospectively collected for patients (pt) enrolled into a tebentafusp access program at two tertiary Australian centres. Data fields included: baseline patient, disease and prior treatment characteristics; and tebe administration, response, toxicity and survival outcomes. Results: From May 2021 to February 2023, 19 pt received tebe for UM: 7 males, average age 61 years (range 39-86). All pt presented with local disease at diagnosis, with time to metastases greater than 12 months (mo) in 15/19. Prior to tebe, all patients had hepatic and 6/19 extra-hepatic metastases (6 bone, 4 lymph node, 2 peritoneal, 2 dermal and/or subcutaneous). Baseline PET scan demonstrated FDG-avid disease in 13/14. Primary disease treatment included enucleation (7/19) and radiotherapy 13/19). For advanced disease, prior systemic therapies included: none (12/19); anti-PD1 (3) or anti-CTLA4 (2) as monotherapy; or in combination (5); and anti-PD1 with anti-LAG3 (2). Prior to tebe baseline LDH was elevated in 10/19 (53%) and average neutrophil to lymphocyte ratio was 9.22 (range 0.9-49.5). The median time receiving tebe was 5.5 mo (range < 1-18). The median progression free survival (PFS) was < 3mo. 5 pt remain on tebe with 2 pt treated with tebe beyond 12 and 18mo duration. Best response obtained by PET or cross-sectional imaging was: a partial response in 4/19, stable/mixed in 4/19, progressive disease in 8/19, and unknown/not evaluable in 3/19. The majority of patients ceased tebe due to disease progression (10), change of therapy (4) or death (2). Only one patient ceased due to toxicity. At last review 14/19 (74%) patients were still alive and 4/19 had received one or more lines of systemic therapy after tebe including immunotherapy (1), targeted therapy (1) and/or clinical trials (4). Common adverse events included: rash (63%), hypotension (47%), pruritis (42%) and pyrexia (32%). Supportive measures were required (e.g. hydration, antihistamines, topical steroids) for 13 patients. Cytokine release syndrome (CRS) was reported in 63% (12/19) with only 3 demonstrating grade 2 severity. CRS management included oral (1) or intravenous steroids (2) and zero patients required additional immunosuppression. The median number of cycles administered as an inpatient was 3 (range 2-10). Conclusions: Within experienced tertiary centres tebe could be safely administered outside of a clinical trial setting. Median time on treatment greatly exceeds progression free survival, likely due to unique response characteristics and limited access to subsequent therapy. Identifying features that enrich for clinical benefit remain necessary for optimising tebe use.