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Dr. Jose Lutzky on Supporting International Uveal Melanoma Patients" · The Eye Believe Podcast

0:25
Hi, everyone.
0:25
Welcome to the I Believe podcast.
0:27
I'm Megan, I'm so excited you're here.
0:29
Thank you for joining today.
0:31
We have some great information
0:32
for you today.
0:33
We have Dr. Jose Lutzky
0:35
from the Sylvester
0:36
Comprehensive Cancer
0:37
Center in Miami, Florida.
0:39
And we're going to tell you all about
0:40
how he can help you or someone you love.
0:42
Doctor Lutzky
0:43
can you tell us more about your uveal
0:45
melanoma program?
0:47
So here in an at Sylvester Cancer Center,
0:51
we see a, large number of patients
0:53
with melanoma.
0:54
Unfortunately,
0:57
a lot of these patients
0:58
eventually develop into metastatic disease.
1:01
because of the nature of this disease,
1:04
we we have a very robust,
1:08
both trial program as well as,
1:10
translational program.
1:12
in addition, because of where we,
1:15
where we are located in the country,
1:17
we see a lot of patients
1:19
that come from Central and South America
1:21
that are looking for options
1:23
to treat their advanced disease.
1:25
What makes a patient
1:26
a good candidate for your program?
1:28
Yes, we we like to have clinical trials
1:31
and options for all patients
1:33
that they need treatment.
1:34
But unfortunately,
1:35
sometimes patients come,
1:37
patients come to us, to sick,
1:40
and they're not
1:41
able to be part of a clinical trial
1:44
or even to withstand
1:46
a standard treatment, for the disease.
1:48
But, that tends to be the minority.
1:51
most patients will be able to fit
1:54
the requirements or what
1:56
we call inclusion criteria
1:58
of one clinical trial
2:00
or another clinical trial.
2:02
once they
2:03
have, exhausted
2:05
the standard of care treatments.
2:06
Oh, that's really great to hear.
2:08
You are able to help these patients.
2:10
Tell us about your international program.
2:12
as I mentioned before,
2:14
because of our geographical location,
2:17
we do see patients
2:18
that come from Central and South America.
2:22
unfortunately, in a lot of these spaces,
2:25
the patients do not have a lot
2:29
of options.
2:30
We treat,
2:31
uveal melanoma, and uveal melanoma is is rare.
2:34
so a lot of these,
2:36
countries in Central and South America
2:38
do not have the, expertise
2:41
or the resources to effectively diagnose
2:45
and treat uveal melanoma.
2:48
and patients have a difficulty in finding
2:51
and medical centers
2:52
that have specialized
2:53
of colleges and colleges
2:55
that, have experience
2:57
in managing these, cancers.
3:00
In addition,
3:01
the other than some
3:03
of the standard therapies,
3:04
a lot of these, centers in the South
3:08
and Central America
3:09
cannot offer
3:10
much beyond the conventional treatment.
3:14
and we and even some of the conventional
3:18
treatment drugs
3:19
that are approved
3:20
in the United States,
3:21
for example,
3:22
preventive first,
3:23
are not approved
3:25
in a lot of those countries.
3:26
So patients sometimes come up here
3:28
just to get what we would consider
3:30
a standard of care, treatment.
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there are issues,
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these, treatments are expensive.
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they usually involve surgery, radiation,
3:42
sometimes immunotherapy.
3:44
and patients had to,
3:46
also deal with the travel costs,
3:49
the medical expenses,
3:50
the insurance coverage, and the patients
3:53
if they have insurance.
3:55
And, and
3:55
and when they get here,
3:57
in addition to try to get a visa,
4:00
they need to arrange transportation, need
4:02
to find accommodation.
4:04
so, so that is all very,
4:07
very, very difficult
4:09
and stressful for this patients.
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you know, they feel,
4:13
more stress and anxiety.
4:15
They may feel isolated
4:17
because they feel that
4:19
they're in a place
4:20
where they cannot get the treatment
4:22
that they need
4:23
to generate that generates
4:25
a lot of energy.
4:26
And what are you seeing
4:27
that's giving you.
4:28
Hope if you asked me this question
4:31
five years ago, even five years ago,
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I would say that
4:36
we don't have enough clinical trials.
4:38
We're not seeing a lot of progress.
4:40
but today,
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I'm happy to say that
4:43
that is no longer true.
4:45
We have, a immunotherapy drug
4:48
that is approved specifically for you.
4:50
If uveal melanoma.
4:51
It's something that we have
4:53
never had a call to them before.
4:56
and we've seen additional progress
4:58
in the area of being in a being,
5:01
particularly with cell therapy.
5:04
and cell
5:04
therapy is
5:05
when we take immune
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cells from the patients,
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and give them back to the patient
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after we modify
5:13
even the immune status of the patient
5:16
or the cells themselves, or both.
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for example, there's some good both in,
5:22
till therapy,
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still more infiltrating lymphocytes,
5:26
in uveal melanoma
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and this research that's being done,
5:30
in Pittsburgh, that's showing
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some, some benefit there.
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we are doing a number of trials with,
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engineer T cells in which,
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the immune system
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warriors, the T cells are taking
5:43
from the blood of the patients,
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and they're modified
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to make them warriors against specific,
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targets in the European melanoma.
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And we're seeing a lot of progress there.
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we are also doing trials for patients.
5:58
They have disease
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that's mostly localized to the liver,
6:01
which is a very frequent site
6:03
of involvement in these patients,
6:05
in trying to modify
6:07
the new, environment in, in the,
6:10
in the liver to, fight those cells.
6:13
And we're seeing some progress
6:14
there as well.
6:15
So I think there's the
6:17
there's just a much more optimistic,
6:20
sense in the research community
6:24
that, like, we have conquered
6:27
the ten years now
6:28
and almost to some degree,
6:30
we we would be able to make progress
6:32
in using melanoma as well.
6:34
However, it's a rare disease.
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You know,
6:38
clinical trials
6:39
take a long time because we don't have,
6:42
you know, that many patients.
6:44
but I think we're moving forward
6:46
as much better based on because.
6:49
Once a patient's
6:50
diagnosed, how quickly do
6:52
they need to find a specialist
6:53
like yourself?
6:54
And then what's the timeline?
6:55
I think it's really important, that,
6:59
someone that is familiar
7:01
with using
7:02
melanoma and has treated
7:04
and diagnosed with
7:05
the melanoma
7:06
sees the patients as soon as possible.
7:08
I think for, for many, many years,
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a lot of people would say, oh,
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it doesn't really matter
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because there's no treatment.
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So there's
7:18
no need to follow these patients.
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but, you know, particularly in, in,
7:24
in, in other countries,
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the main form of primary
7:29
treatment of this patients
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is to do an operation, patients
7:34
get to, to the doctors
7:36
that can treat them too late.
7:37
The disease is too locally advanced.
7:40
So they lose their vision and necessarily
7:42
because now, in the U.S., at least,
7:46
most of these patients are treated
7:48
with radiation therapy
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with brachytherapy.
7:50
And that, saves their patients.
7:53
And there are ways now
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to prevent
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radiation related loss of vision,
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that,
8:00
may, may
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not be available in other places.
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So I think it's important
8:07
in oncular oncologists,
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wherever they are,
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they has experience
8:14
with technology today,
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you can have a consultation,
8:19
in telemedicine,
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with an ocular oncologist.
8:22
This or with a medical oncologist,
8:24
afterwards,
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to see
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what would be the right course of action.
8:29
we can now with specialized staffs there
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are done
8:34
find, you know, biases at the
8:36
time of the treatment
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with, radiation therapy to,
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to to find out if this is the type of,
8:44
you know, at all,
8:45
but it's likely to come back
8:47
or if this is a type of,
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that most likely
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is not going to come back,
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and then you can tailor
8:53
the follow up plan according to that.
8:55
That's tremendously important.
8:58
if someone has a very low risk,
9:00
they don't need
9:02
to worry about it as much.
9:03
But if they're very high risk,
9:05
they need to be followed.
9:06
They need to have scans periodically.
9:08
Because the sooner you find
9:11
that there is a recurrence,
9:12
the more likely that patient's
9:14
chances of, responding and living longer.
9:18
are.
9:18
So, I think it does
9:20
make a lot of difference
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whether someone sees a specialist or not.
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And how
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can we get these resources
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to the patients who are watching this?
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I think, once, a patient
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with an international patient
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that we are talking about here,
9:40
is diagnosed with uveal melanoma,
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I think it will depend a lot
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on where they are.
9:47
in some countries,
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there is specialized care,
9:51
at least for the primary treatment.
9:56
versed in doing the moderate, treatments.
10:00
but, what there isn't
10:02
much in many, many countries is,
10:05
the care for patients
10:06
that have recurrence
10:07
of metastatic disease.
10:09
as I mentioned before, there
10:11
there are no other approved drugs.
10:13
And, and there's a paucity
10:15
of clinical trials.
10:17
there's more of that in, in Europe,
10:20
for example.
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But, for patients that come from
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central South America,
10:26
the African subcontinent, that, that,
10:29
that also, is a problem.
10:33
So the best way to do that is,
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once they've been diagnosed,
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they've been
10:38
they receive the primary treatment, and,
10:42
and they're found to be a high risk.
10:45
I think that's the time
10:47
to, to seek a consultation.
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like I mentioned before,
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I think a lot of us,
10:52
a lot of centers
10:53
now are doing telemedicine, visits,
10:56
with these patients.
10:57
I don't think they need to,
10:58
you know, run to the United States
11:00
right away.
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I think they need to talk
11:02
to someone first,
11:03
find out what their risk is.
11:05
If there's anything going on at that time
11:08
that could decrease that risk,
11:10
that could only be done here.
11:11
or if there isn't,
11:14
they need to be monitored properly.
11:16
And if there is a recurrence,
11:18
that's
11:18
another point
11:19
where they need to consult and see,
11:22
what's going on.
11:23
in the United States
11:27
during that,
11:29
that they,
11:30
we have an international office.
11:32
So there's two, two ways.
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One is through the international office
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or through the, melanoma program,
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through our navigators and navigators.
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If it's an international patient,
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the navigators will, you know,
11:50
will orient patients to go.
11:53
They'll put them in contact
11:54
with the international office.
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I actually think it's
11:57
usually better
11:58
to come through the melanoma program,
12:01
because the international office
12:02
sometimes can,
12:03
can take longer than they need.
12:05
So
12:06
the first step, yes, it's
12:08
to go through the,
12:10
melanoma program navigators.
12:13
And and we have two navigators
12:17
that usually help the patient,
12:20
you know, where to go.
12:22
And if they're international,
12:24
they go through the international office
12:26
and they arrange for that.
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if they're not,
12:29
you know, they
12:29
they can
12:31
arrange for an appointment immediately.
12:34
Yeah.
12:37
Yeah.
12:37
I think a
12:38
significant number of patients,
12:40
although not the majority,
12:41
get,
12:42
incidentally, found to have your
12:45
human element.
12:45
So if someone's in the habit
12:48
of seeing an ophthalmologist,
12:49
they haven't or ice checked
12:51
once a year or so.
12:53
I think that can help
12:54
pick up these things.
12:55
relatively early, unfortunately.
12:58
You know, the patients, just, Yeah,
13:02
you know, present with loss of vision
13:04
without any hint
13:06
that, that anything is going on.
13:09
But but I think,
13:10
I've seen a number of patients
13:12
in which this was picked
13:13
up, incidentally, without any symptoms.
13:17
And it's probably no good.
13:18
1520 and,
13:20
and whenever there is
13:21
any kind of visual symptom
13:23
not to ignore that, you know, to
13:26
wait until,
13:27
you know, they can't see anymore.
13:29
And then sometimes that happens,
13:30
I think I think patients,
13:32
also sometimes sense that if something
13:35
bad is happening
13:36
and they don't want to know
13:37
about it, that it's sort of instinctive.
13:42
Thank you, sir.
13:44
Thank you.
13:45
Have a great weekend.
13:46
You're well.
13:49
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13:51
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13:53
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