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Eye Believe Survivorship Seminar 2025 | Yesterday, Today & Tomorrow in Ocular Melanoma · The Eye Believe Podcast

0:09
a huge a welcome to everyone
0:12
um I'm April Salama
0:14
I'm one of the medical oncologist at Duke um
0:17
obviously
0:18
with an interest in melanoma and ocular melanoma
0:21
and it's a real privilege to be here
0:23
to have been asked to host this event with my colleague
0:26
Doctor Materin
0:27
I think we have a wonderful program here for you all
0:30
today and again
0:31
I thank you for coming and
0:33
and um
0:34
you know this is a true partnership
0:36
and we're we're really appreciative that you're here
0:40
well let's get this uh started
0:43
okay um
0:44
well first of all
0:45
if we were in Argentina Saturday
0:47
8:00 will be considered Friday night
0:50
so um
0:51
apologize and um
0:53
I'm from Argentina if you don't understand my English
0:56
I have several translator here
0:58
that I've been working with for several years
1:00
okay um
1:03
my presentation is to um
1:05
to talk about where are you
1:07
where are we coming from
1:09
where we're at today and where we're going
1:15
uveal melanoma is the most common primary
1:17
intraocular malignant tumor
1:19
in adults
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it represents 3 to 5% of all melanomas in the body
1:25
the incidence is between 5 to 7 um
1:28
cases per year um
1:30
per million in United States
1:32
the average age is 55 to 60 years old
1:36
mostly in white people
1:38
and the most common places that it gives metastasis
1:41
is to the liver and lungs
1:46
when we see a patient with um
1:49
uveal melanoma what are our priorities
1:53
life is number one you may say
1:55
well that makes sense
1:57
oh you won't believe that
1:59
that other people many people
2:01
they think oh well
2:02
I'll lose my sight well
2:03
I'll lose my eye
2:05
so that's when we need to restart the conversation
2:08
and we tell the patients we need to um
2:11
take care of your life first
2:13
your eye second and vision in
2:16
we are the only ophthalmologists
2:18
that vision is our third priority
2:23
traditionally um
2:25
ocular melanoma, uveal melanoma has been um
2:28
classified in small medium
2:31
or large now
2:34
back in the day 23
2:36
30 years old
2:37
we didn't know why some patients will have metastases
2:41
and some patients will never have metastases
2:45
so now we're going backwards
2:47
we're going into the past
2:49
and let's do a little bit of history here
2:52
let's talk about the past first
2:55
the first article I found about uveal melanoma was that
3:00
um was dated in 1891 by a doctor
3:05
Doctor Reed in Glasgow
3:08
Henry Stallard he's the
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he was the pioneer
3:12
in the plaque treatment for uveal melanoma
3:16
did you guys know that I found that
3:18
that was interesting so uh
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he started with the plaques in the
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in the 30s so when he was running
3:26
he was a medical student and
3:28
and then he presented this paper in 1966
3:33
after treated 100 patients with uveal melanoma
3:36
with a cobalt plaque
3:37
that was the start of the brachytherapy for us
3:42
so let's talk a little bit about uveal melanoma past
3:45
present and future
3:47
the way I see it so this is me
3:51
how I live this uveal melanoma
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in the 80s I was still a medical student
3:58
um
3:59
the main concern was diagnosis uh
4:03
is this melanoma is this not melanoma
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let's wait for growth etcetera etcetera
4:07
so there was a challenge in diagnosis
4:11
COMS the Collaborative Ocular Melanoma Study
4:14
started in the 80s and one of the um
4:17
the arms for that study was
4:19
what is better plaque or enucleation
4:23
some of the doctors knew that plaque and enucleation
4:26
had the same life prognosis
4:28
so some of the centers abandoned the COMS
4:31
but lots of reports came from the COMS
4:37
in the 90s we had a second tool to treat this um uh
4:41
to treat patients and that was the TTT laser
4:44
so we have very a high enthusiasm with the
4:48
with the TTT only and there were some problems 5
4:51
10 years later so today
4:53
the TTT laser is used mainly
4:55
as an adjuvant treatment for the plaques
4:58
we've learned the risk factors for growth
5:01
and I want to be clear about this because um
5:04
many of many of you and
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and many doctors trainees etcetera
5:08
they think that the risk factors for
5:09
the risk factors for growth is for all melanomas
5:12
or any pigmentation we see in the eye
5:14
no it's
5:15
this is for small small melanocytic choroidal lesions
5:19
and the risk factors for growth means okay
5:22
what are the chances that the lesion I'm seeing
5:25
has to grow why
5:28
because most of the time growth is considered melanoma
5:32
but that is for small tumors
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um the reports from COMS started to show up
5:37
and there were more than 40 reports for
5:40
for that from that perspective trial
5:44
in 2000 well
5:47
we started to trying to save vision
5:50
how it was like in first of all
5:52
was steroids injections around the eye
5:56
then we started to use the steroids injections
6:00
within the eye
6:01
and there were improvements in vision within a
6:05
within a week but didn't last more than six months
6:09
so uh
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sometimes it's used sometimes it's not
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these days we don't use that as the primary treatment
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to preserve vision and we started to do biopsies
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the first time I've heard about the biopsies
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was when I visited Doctor Damato in Liverpool
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and he was telling me well Miguel
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there are some good melanomas and some bad melanomas
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and what they use in Europe is the chromosome analysis
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and at that time it was the chromosome 3 analysis
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monosomy 3 worse prognosis
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disomy 3 worse prognosis
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and we started with the G E P
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gene expression profile that's what we use
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and most centers in United States use
6:55
for the biopsy results
6:57
to check the prognosis on these patients
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on the patients
7:03
2010 um
7:06
more information from the gene expression profile
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saying class 1 or class 2 was not enough
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then who was a class 1 a or a class 1 b
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is that when a prame started
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also in the late uh
7:22
a late yes
7:22
in the 20s so I got prame in here too
7:25
so um
7:26
and we found about the gene mutations
7:29
and we have new medications to preserve vision now
7:35
I think it's important that we are talking about vision
7:38
because vision here well
7:40
patients are alive
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that's why we're concerning about vision
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patients are living longer than 40 years ago
7:51
in the 20s well
7:54
the FDA approved the first medication
7:57
for metastatic melanoma
8:00
um and that was in 2022
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that was Tebentafusp was not for every patient
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was for a good percentage of patients
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with metastatic disease
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new medications to preserve vision
8:15
and more in the 20s
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we have the COOG Collaborative Ocular Oncology Group
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that's a group of 27 centers working together
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analyzing and collecting data on more than 1500 patients
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and we have
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I'm gonna show you the results from the COOG now
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from COMS in the 80s until COOG in the 20s
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this is almost 40 years
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so we did not do a good job about working
8:48
collaborating together
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trying to find answers to uveal melanoma
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we have now also the NCCN Guidelines
8:58
Uveal Melanoma Subcommittee
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so there are some guidelines
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and I'm going to share this with you
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because this is important information for all of you
9:08
um in future
9:12
little bit present more the future
9:15
about liquid biopsy
9:17
doing an um
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a blood test trying to know which patient will have
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or which patient will not have
9:25
metastatic disease let's go a little bit over all this
9:29
these are the results from COOG
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look at the the date July 2024
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and the prame was analyzed
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it was a
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another marker to know more about the prognosis is
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is this uveal melanoma
9:44
prame positive prame negative
9:47
let's look at that all together
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so at the top you see the normal melanocyte
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and at the bottom
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is how it goes from a normal melanocyte
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that's a cell with pigmentation
9:59
to metastasis and you see different arrows there why
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because some some patients
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um they have um
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better prognosis than others
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some are intermediate uh
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prognosis risk for metastasis
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and some worse prognosis now
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I want to be clear and this is what I tell my patients
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class 1 prame negative is the next
10:27
is what we're looking for
10:29
class 2 prame positive is more concerning
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but what I tell our patients
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is that we're talking about higher or lower risk
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why because um
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we've seen some patients class 1 with metastases
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we don't know why because there's some other factors
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but this is the standard of care these days
10:52
that we do the biopsy we get this result
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Castle has been doing a great job
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and we've been working with Castle for the past
11:00
15 or 20 years prame is a new information
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and at the top you see the first mutations
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the most common ones are
11:11
GNA-11 and GNA-Q
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I will say um
11:16
the most specific mutations for melanoma
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why is this important have you heard of target therapy
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target therapy means that there will be one day
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some specific medications
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to work on these specific mutations
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okay
11:38
now let's talk a little bit about
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the National Comprehensive Cancer Network the NCCN
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as January of 2025 1888 NCCN guidelines
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features 228 algorithms that apply for 97% of cancers
12:00
in United States and globally
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there are 63 NCCN panels
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more than or almost 2,000 panel members
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more than 49,000 hours contributed by panel members
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in 2024
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these are the members of the NCCN
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and you can see that at least
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Doctor Salama and I were part of it too
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what's the mission and the vision for the NCCN
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mission is to define advance quality effective
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equitable and accessible cancer care and prevention
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so all people can live better lives
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what's the vision access to high quality
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high value patient centered cancer care for all people
12:55
national and globally
12:59
I'm gonna tell you at the end
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what I think about all this
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um the NCCN guidelines
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are the most thorough and most frequently updated
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clinical practice guidelines
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available in any area of medicine
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the recognized standard for clinical policy
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in cancer care in United States
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widely available free of charge for non commercial use
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and this is my main point here
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it creates the basis for insurance coverage
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policy and quality evaluation
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why am I saying that everything is great
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but what we care about is this last point
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because these are NCCN guidelines
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33 centers
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formed by panels
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who are mostly experts in the field
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setting the guidelines for the treatment of uveal melanoma
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so nobody
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meaning the last there uh
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will say oh no
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this is experimental this is this
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this is that well
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NCCN guidelines doesn't say that
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so this is uh facts
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these are facts that's why the NCCN guidelines
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they said the basis for the treatment
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what about the NCCN guidelines for uveal melanoma
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there is a subcommittee for that
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and it's complicated and you don't need to
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you know all this
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I mean basically
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it's including every single information
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we know about uveal melanoma
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and it talks about diagnosis
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it talks about prognosis it talks about treatment
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it talks about metastatic disease
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clinical trials etcetera etcetera
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so this looks simple right
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but every page almost every page has footnotes
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but if if
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but well
14:59
in this case in that case
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etcetera etcetera
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so we are thinking about
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we're trying to include all the possibilities on
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for the patients with uveal melanoma
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with any any features
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look at the treatment for metastatic disease
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on the footnote and is
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there is another footnote page
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the NCCN guidelines for a uveal melanoma is like 30 pages
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but this is people
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medical oncologists ocular oncologists
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um radiation oncologists
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everyone
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we meet one or twice a year for three or four hours
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and we are discussing
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every single word you see in there
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present and future
15:45
well
15:47
Tebentafusp the first medication
15:50
that was approved by the FDA for metastatic disease
15:53
this is present
15:56
the second medication
15:57
now we have two medications that have been
16:01
or two treatments that have been
16:02
approved for metastatic disease
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this one is 2 years ago
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there is new medications
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that are being evaluated for systemic treatment now
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you ask me
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and I think this is personal opinion
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okay so
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this is not just how I see
16:25
this is gonna happen in the future
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I think that in X amount of years
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uveal melanoma is gonna be treated with an oral pill
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that's what I think that's gonna happen
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and everything Stallard and many did with the plaque
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probably will be history I don't know
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I don't know when that's gonna happen
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but it seems that this is the way
16:45
because some of the patients
16:48
that were treated with this medicine they
16:50
this medicine decreased the tumor size almost 50%
16:54
so that some patients are responding
16:57
all of it but again
16:59
this was not approved
17:01
what about the liquid biopsy
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you cannot imagine how important this is
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and it's happening these days
17:08
still at the research level
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to take a sample for the interior portion of the eye
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with a very simple procedure
17:16
that can be done we don't
17:17
but can be done in the office
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taking a tiny sample one drop
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that was gonna tell us there is DNA floating in the eye
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DNA from melanoma also
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we're looking for DNA in the bloodstream
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patient doesn't have metastasis
17:34
we don't know but we look for this liquid biopsy
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from the plasma cells of the
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of the blood cells and we'll see if there is CT
17:43
DNA floating in the bloodstream
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and that patient may have some time in the future
17:49
metastasis so this is
17:52
this is a very hot topic
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and there are multiple centers working on this
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not only for uveal melanoma but for other cancers
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in summary
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uveal melanoma is a teamwork
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this is not a one person show
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that doesn't is
18:11
does not
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important how big the ego is of the treating physician
18:16
if that great physician very knowledgeable
18:20
doesn't have a team behind him her to support the work
18:26
it will not be good for us
18:30
the consultation starts when Jessica
18:34
our staff assistant receives the a
18:36
the referral from the referring doctor
18:39
the referring physician is important too
18:41
some patients come long distances
18:43
some patients you know
18:44
drive many hours
18:45
and will be working with the referring physicians
18:49
the staff assistant oh
18:51
if if
18:52
if we don't have one that works well
18:55
and we don't train uh
18:56
it's gonna be a problem for the patient
18:59
patient will be you know
19:01
wandering around and where am I going
19:03
etcetera etcetera
19:05
the technicians they have multiple roles
19:08
um some of you know Howard
19:12
he's the technician who's cries for me
19:15
um
19:17
I call him my boss because I do
19:19
and I go wherever he tells me that I need to go
19:22
and I whatever I need to do
19:23
he follows me you know
19:26
can I go I ask him
19:27
can I go to the restroom yes
19:29
but you have three patients waiting
19:31
so this is the kind of you know
19:33
I asking for can I have a break
19:35
like my yogurt lunch
19:36
salad etcetera
19:37
yeah you can go now
19:39
that's Howard you know that okay um
19:44
they are going to evaluate the patient
19:46
the technicians evaluate the patient
19:48
when the patient comes and visual acuity
19:51
taking the history reading the notes
19:53
putting the notes etcetera etcetera
19:56
the photographers
19:57
if we cannot document what we see today
20:00
we cannot evaluate what's
20:02
how the patient looks in the future
20:05
so those those roles are very important
20:10
fellows and residents
20:12
this is an interesting topic
20:15
why because we may have a great year
20:17
I call it a sabbatical when
20:20
you know I just
20:21
I don't well
20:22
now we have what
20:24
I do what Howard tells me
20:26
and now I do what the fellow tells me
20:30
so I have two people telling me what to do
20:33
we have one that is not good
20:34
then we have a tough year
20:36
so the team is important everyone ocular oncologist
20:40
the surgical coordinator
20:43
so in our case is Michelle
20:47
and since we got Michelle
20:50
she's like give me more to do
20:52
give me more to do I want to do more
20:54
she's doing everything
20:56
we cannot be happier when the patient tells us
20:59
thank you for making this uh
21:02
stressful time a smooth one
21:04
because Michelle and Jessica
21:06
and everyone I'm mentioning
21:07
you know they do they
21:09
they prepare the whole um
21:11
road for the patient I'm
21:14
I'm naming them
21:15
because these are the people we work with
21:19
radiology they are ready to
21:21
you know patient comes long distance
21:23
they trying to help us
21:25
doing the CT scans on the same day that um
21:27
we're seeing the patient
21:30
radiation oncology we have
21:32
you know there is a permanent communication
21:35
what type of plaque what the size
21:37
what the doses etcetera etcetera
21:40
medical oncology and her team
21:43
and it requires some hours to work together
21:47
and find out okay
21:48
what's best for the patient
21:50
and they are the ones who know everything
21:53
about these systemic treatments
21:55
they teach us all the time
21:58
and when I I put their clinical trials
22:01
and I mean in their clinical trials um
22:03
that's what I would like to include industry
22:06
I will um
22:07
because that's a partnership that we need
22:12
without these companies um
22:14
and I'm not gonna name anyone in particular
22:17
because I'm I'm going to forget one um
22:20
but without them working with them
22:23
we cannot find all the treatments
22:25
and everything that we are showing
22:27
you are going to hear today
22:31
I'll be happy I think that's my last slide
22:33
I'll be happy to answer any question
22:35
or start any debate with my colleagues
22:37
thank you so much
22:41
can you talk to us about you know
22:44
kind of how you
22:45
maybe decide the difference
22:46
between someone who might need surgery
22:48
like a enucleation or someone who might need a plaque
22:51
and and what that
22:53
what that difference is
22:54
because sometimes I hear there's this fear
22:56
you know we just
22:57
we just gotta take the tumor out and um
23:00
you know how that decision making works
23:03
so um
23:05
large
23:06
large blind a um
23:10
it's annoying to hear myself
23:13
so large a blind
23:15
painful eye that goes for a enucleation um
23:19
for big tumors it's basically based on the
23:22
on the size uh
23:24
if the the patient can have a plaque
23:26
we're gonna do a plaque um
23:28
we explain to patients that there is no advantage
23:31
and that's one of the things that COMS showed
23:33
is that there is no advantage uh
23:36
removing the eye over doing the plaque therapy
23:39
so that's why the plaque therapy
23:41
is the most common treatment worldwide
23:44
but it's mainly based on the size and prognosis yes
23:48
what do we have in new targeted therapies
23:49
and how quickly are they advancing
23:51
and are these targeted therapies for the eye
23:53
or targeted therapies for the liver
23:56
not fast enough okay um
23:58
I wish we had that like yesterday
24:01
I see Aura nodding their heads and
24:03
and um
24:04
what I um
24:06
with uveal melanoma we run behind medical oncologists
24:11
when they treated cutaneous melanoma
24:14
the first time I've heard
24:16
I personally heard about immunotherapy
24:18
targeted therapy was back in 2010
24:21
for cutaneous melanoma please
24:23
April correct me if I'm wrong
24:26
and so and I show you that until 2020 um
24:31
we didn't know much
24:33
we didn't have much more information about uveal melanoma
24:35
so we are
24:37
I would say almost 10 uh
24:39
10 years behind the cutaneous melanoma
24:43
and it's reasonable
24:43
because there are way much more people with cutaneous
24:48
so I've learned about BRAF and NRAS in 2010
24:54
and I've learned about GNA-11 and GNA-Q
24:57
probably late um
24:59
you know five
25:00
six seven years later
25:02
BAP1 one that we've learned about that later on
25:06
so now having said that
25:09
let's look for the good thing
25:12
the FDA um
25:13
has been very interested in um
25:17
uncommon disease and uveal melanoma is one of them
25:22
so there is a um
25:24
there is a large interest in um
25:26
less common conditions like uveal melanoma
25:29
so I think now we're going faster
25:32
so three years ago no medication
25:35
in the past three years now we have two
25:39
so it's happening and I think it's happening um
25:43
fast maybe not as fast as we want
25:47
but definitely faster than it used to historically
25:50
definitely I mean I
25:51
I've been diagnosed for just over five years
25:53
and you guys I mean
25:55
I hope I hope I can convey just how involved like
25:58
I've been from the four and a half year mark on
26:01
from that six months that I told you about this morning
26:04
the changes I've seen in the four and a half years
26:06
from March 2021 to now it's insane
26:10
in the best of ways um
26:12
and so if you guys watch me on social media
26:14
and you're like how do you
26:15
how do you have such a
26:17
I don't want to say a positive attitude
26:18
but a like
26:20
a hopeful attitude
26:22
maybe it's because I have a huge awareness
26:25
from talking to doctors like Doctor Materin
26:27
and from understanding just how far we've come
26:30
like he's demonstrated today
26:32
so what was your I guess
26:34
your inspiration behind becoming an ocular oncologist
26:37
who really focuses on ocular melanoma
26:40
1992 I was a retina specialist in Argentina
26:45
there was no ocular oncology in Argentina
26:49
and I so
26:51
most uveal melanomas were treated by retina specialist
26:55
and I received my uh
26:57
first patient the first referral was 1992
27:00
I treated her with a cobalt plaque
27:04
and
27:06
there was nobody no ophthalmologist
27:09
who was very interested in this topic
27:13
it's scary and um
27:16
again I'm talking about 30 years ago
27:19
and it started to be more and more um
27:23
interested to me interesting to me
27:25
and um
27:27
um in 1996 um
27:32
well
27:34
and more patients were coming
27:35
I said well
27:36
I better know this much more than what I do
27:39
so I visited Wills for two weeks
27:42
and in two weeks I'd seen um
27:46
many patients maybe more than anyone in Argentina
27:51
in their entire careers
27:53
too late two years later I uh
27:56
went to visit uh
27:58
Wills again for one week and that's when um
28:02
Doctor Carol invited me to do the fellowship with them
28:06
so I said well
28:09
let me ask my wife
28:12
she was in Argentina at that time
28:14
so I was like it's not gonna happen
28:18
so then she said well
28:20
I told her and
28:22
and we have four kids
28:24
and um
28:27
and there was nobody on ocular oncology train
28:32
fellowship train in my country
28:35
and when when Doctor Shields offer that to me
28:38
um and my wife was like
28:41
well we can come for four months
28:44
and I was like Miguel
28:45
you're screwed you're coming for the whole year
28:48
and uh
28:49
and that's what happened so few months later
28:52
we were here doing the fellowship
28:55
that's amazing thank you thanks for sharing
28:59
all right do we have any other questions
29:00
oh we have one on paper
29:02
thank you guys for following directions
29:04
I feel so happy
29:06
okay this is how my job is supposed to look
29:08
especially on the medical day
29:11
okay 50 ocular oncologists in the United States
29:14
is that a rough a rough
29:15
correct estimate uh
29:17
fifty 50
29:18
as in 50 I think that full time is less than that
29:23
okay right
29:24
Hakan what do you think
29:25
it's 20 30
29:27
20 to 30 okay
29:28
to 30 full time okay
29:31
so what's the difference then
29:32
between a full time ocular oncologist who
29:37
because there are some
29:38
and I'm not saying they're not expert
29:40
but there are some doctors who treat other conditions
29:44
like retina and they do some retina
29:47
some diabetes etcetera
29:49
and oncology is part of them
29:50
from their work in
29:52
in our work it's full time ocular oncology
29:55
OK and this is
29:56
I guess kind of a follow up question
29:58
um
29:59
in in that number
30:00
if there's say
30:01
20 to 30 full time ocular oncologists
30:04
meaning they're the
30:05
you guys are the ones who treat the eye
30:07
and then April
30:08
like Doctor Salama um
30:10
Doctor Moser Doctor
30:12
any of our medical oncologists
30:14
do we have any kind of a rough
30:15
ballpark number
30:16
of how many medical oncologists there are
30:18
who specialize in uveal melanoma
30:20
just kind of in comparison
30:22
that's a question for you April
30:25
um you know
30:26
it's tough I mean in terms and April
30:29
do you want to come up here
30:30
and I'll let you answer on the mic
30:32
sorry
30:32
I didn't realize if it was gonna be a quick number
30:35
I would just say tell me the number
30:36
but if you have things to say
30:37
I want you to be able to say them
30:39
thank you thanks
30:40
um so it's
30:42
it's tough because um
30:45
you know uveal melanoma is a rare cancer
30:48
and for a medical oncologist um
30:52
it is difficult I would say
30:53
to exclusively focus on ocular melanoma
30:57
um certainly
30:58
there are medical oncologist
31:01
whose practice is predominantly ocular melanoma
31:05
especially at very large centers
31:07
you know places like MD
31:09
Anderson Memorial Sloan
31:11
Kettering that see large numbers of
31:13
of melanoma patients but even just taking a step back
31:18
there are not that many of us that focus
31:19
on just melanoma I would
31:21
I would put that number you know
31:24
probably double to triple at at
31:27
you know so
31:27
but I think there are less than probably 100
31:30
you know medical oncologists in the country
31:31
who focus on melanoma and then most of us
31:35
I certainly
31:35
focus on ocular melanoma as a subset of that practice
31:40
but even in kind of ocular melanoma specialist
31:42
they will tell you
31:44
about a half to two thirds of their practice
31:46
are patients with ocular melanoma
31:48
um for us at Duke
31:49
I mean because of the fantastic work of Doctor Materin
31:51
and Doctor Maniar um
31:53
Duke is such a major you know
31:54
referral center throughout the Southeast um
31:58
that it's about a third we think
32:00
of our patients are ocular melanoma patients
32:02
so kind of focus on it within the context of um
32:06
a dedicated melanoma clinic
32:08
okay I think that helps
32:09
um Doctor Materin
32:10
do you have anything to add
32:12
okay alright
32:13
um this is the last question
32:15
and then I think we're gonna go ahead
32:16
and take a break for the day
32:17
if you guys do have more questions
32:20
especially pertaining to anything that
32:21
you know a question that Doctor Materin might answer
32:24
pertaining to ocular oncology
32:25
we will have the next session
32:27
we're gonna be continuing
32:28
talking about the ocular melanoma phase
32:31
um
32:32
what is it ocular melanoma after treatment
32:36
that's gonna be our focus for the next session
32:38
but as our final question
32:39
do you both agree
32:40
or do you both believe that it's important
32:43
in ocular oncology and in medical oncology
32:46
for patients to see someone who specializes in
32:49
uveal melanoma and or
32:51
you know ocular melanoma
32:52
like an ocular oncologist versus a
32:53
like a I okay
32:55
I'm gonna break this question into sorry
32:58
do you think it's important for a patient
32:59
who's being treated in their eye
33:01
to be treated by an ocular oncologist versus say
33:04
a retina specialist who also
33:07
you know a retina surgeon maybe
33:08
who also treats ocular melanoma
33:10
but it's like not his primary or her primary
33:14
we're live right
33:15
we are live yes
33:18
no pressure
33:22
so um
33:24
definitely ocular oncologist
33:26
okay um
33:27
but there are some retina specialists who will
33:29
well trained okay
33:31
and they are up to today information
33:34
mm hmm and that's okay to
33:38
to to to
33:39
to treat other conditions
33:41
okay um
33:41
so I cannot say that only ocular oncologist um
33:46
that's not fair um
33:48
because you may have someone with
33:50
who was ocular oncology trained
33:52
and it's in an area that there are few patients with
33:57
with ocular melanoma and they need um
33:59
you know I need to
34:01
to go to the supermarket and then
34:03
you know yeah
34:04
so there are people not full time oculonologists
34:09
they're retina specialists
34:11
that they they are capable to treat this condition
34:14
okay yes
34:15
alright I love the answer to that question
34:17
and um
34:18
I'm going to have Doctor Salama answer the question
34:21
as well for the medical oncology side
34:24
with the caviat
34:25
that we are just gonna let her give a teaser
34:27
because
34:27
she's going to be talking more about this at 11am
34:30
in our track 1 session yes
34:33
I so I will talk
34:35
talk about this uh
34:36
touch on it a little bit actually in
34:38
in our session but um
34:40
you know completely agree with everything that
34:42
that Doctor Materin said I
34:45
I admittedly am biased um
34:48
but I I do think it's important to at least
34:51
have a consultation with a medical oncologist
34:54
who specializes primarily in melanoma
34:57
and then and then uveal melanoma
35:00
to get kind of a general overview
35:02
and education and guidelines
35:04
I acknowledge though
35:06
and we will talk about this a little bit about
35:09
you know we're not close to some people um
35:13
we're working on ways to use technologies
35:16
things like telehealth
35:18
things to make it more accessible um
35:21
for patients to come get their follow up
35:23
but we also acknowledge that
35:25
that that's just not realistic for a lot of patients
35:29
I do what I do think is important
35:31
is that they are seen by a medical oncologist
35:34
as part of their surveillance
35:35
um you know
35:36
I do not think for example
35:38
being seen by a primary care doctor
35:39
just ordering a scan um
35:42
we are looking at our own scans
35:44
we are kind of consult you know
35:45
uh having consultations with our radiologist
35:48
of any questionable findings
35:50
and that's
35:50
really out of the scope
35:51
of a primary care doctor's practice
35:53
so I do think
35:54
you know partnering
35:55
sometimes it's that teamwork
35:56
that partnership with a you know
35:58
a medical oncologist at an academic center
36:01
who maybe has a more subspecialty focus
36:03
and an oncologist you know
36:04
perhaps practicing closer to home
36:07
um I'm not gonna be that nice
36:09
um I think that um
36:12
medical oncologist
36:13
must have experience in treating uveal melanoma
36:17
if the medical oncologist does not know what uh
36:20
class 1 prame positive is
36:23
so that's not the person to um
36:26
to do the follow ups or to monitor these patients
36:30
so I'm not talking about specialist
36:32
I'm talking about
36:33
people who are informed about what you do
36:36
and they have experience about the new medications
36:39
about the new treatments and the
36:40
about the prognostic factors etcetera etcetera
36:43
so that has to be a person um
36:46
with experience in the topic
36:49
and by the way um
36:50
if you are shy we can answer questions later in person
36:54
so um
36:55
we'll we're gonna stay here all day
36:57
yeah thank you
36:58
um thank you
36:59
Doctor Salama doctor matter
37:00
and let's give them a round of applause