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Transforming Patient Care in the West | The Eye Believe Podcast · The Eye Believe Podcast

0:03
hey omies welcome back to the Eye Believe Podcast
0:05
today I am joined by Doctor Mehmi
0:08
from The Angeles Clinic and Research
0:09
Institute in California
0:11
Doctor Mehmi thanks so much for joining us
0:13
oh thank you thank you for having me it's
0:15
it's great to talk to you again
0:17
yeah I'm super excited I feel like um
0:19
I've heard a lot about you especially in the last year
0:22
just from like some of the
0:23
the friends that I have in the pharma companies and uh
0:26
and I'm super
0:26
excited to hear what you guys are doing at The Angeles
0:28
Clinic for Uveal melanoma
0:30
but can you just tell us first about how your profession
0:33
as a medical oncologist
0:34
intersected with uveal melanoma in the first place
0:38
right so you know after
0:41
undergrad I was interested in cancer research
0:44
I didn't know what path I was gonna take
0:48
as a researcher or a healthcare provider
0:50
so I worked in a at at UC Berkeley
0:53
National Lab for about couple of years and got some
0:57
you know research experience
0:59
under my belt and that made me realize I definitely
1:01
am a people person I need to be around
1:03
people and you know with however help I can
1:07
provide them with
1:08
so I ended up going to med school and um
1:11
eventually after finishing my residency um
1:15
and was hired at WVU
1:17
Cancer Institute as a medical oncology provider
1:20
and my focus
1:21
was supposed to be breast cancer at that time
1:24
because that's where the need was um but
1:26
along the way within about a year of my employment
1:30
one of our medical oncologist who had been doing
1:33
melanoma and other malignancies of cutaneous origin
1:38
um ended up leaving
1:39
so they needed help and that was the starting point
1:42
after that that sort of seed
1:45
led to my interest in melanoma
1:47
that led to establishing a um ocular oncology program
1:53
with the help of the
1:55
the ocular oncologist at the WVU Eye Institute
1:58
and I've never looked back since and uh
2:02
been here at The Angeles
2:03
Clinic for about six years now and
2:06
continue to work very closely with Doctor
2:08
Hamid the world renowned
2:09
melanoma oncologist I've learned a great bit from him
2:13
and now sort of trying to spread my own wings uh
2:16
within the ocular oncology field
2:19
yeah absolutely um so I want to just clarify
2:22
in the Angeles Clinic do you guys have ocular
2:25
oncology and medical
2:26
oncology like do you have the ability to kind of
2:28
send people around to both so we
2:31
do not have a dedicated
2:33
ocular oncologist but we do partner with um
2:36
some of the ocular
2:37
oncologist that that are available at UCLA at USC
2:40
and Doctor Zack Oakey out in um Pasadena area
2:45
um so there are number of providers
2:47
ocular oncologists that we work very closely
2:49
with and able to see their patients on a very expedited
2:52
um manner um and
2:55
I think one of the benefit of The Angeles Clinic
2:59
is that the availability of number of clinical trials
3:02
at any given day that we're able to offer
3:06
to our patients with you know various
3:08
different types of of of malignancies especially
3:11
um you know uveal melanoma yeah absolutely well
3:15
this is something
3:16
that you know we wanna touch on for sure
3:18
um in the west region if patients are looking for care
3:21
what kind of access to those clinical trials
3:23
would they have um
3:24
I guess let's start with let's go ahead and start with the clinical trials
3:27
since you mentioned
3:27
that and then we can go back to kind of more
3:29
standard of care FDA approved options great
3:32
so you know within clinical trial setting our goal
3:36
always is to make sure we cover all spectrum of stages
3:40
of disease right you wanna make sure that um
3:44
there are adjuvant options for high risk patients um
3:47
and there if there are any neo adjuvant
3:49
research going on we make sure
3:51
either we bring the trial here I'll or I'll
3:54
find a place where some neo adjuvant
3:56
studies are going on in ocular
3:57
oncology and and we know there's plenty of
4:00
movement there um and then uh for first line um
4:05
and for later line therapy you know
4:07
talking about Replimune versus um
4:11
you know trying to expand on Chopin study
4:14
um or looking at some late line therapies with
4:18
bringing on external IITs from Doctor
4:21
Tarhini over at Moffitt
4:23
his trial is available at our site
4:25
and then we have number of phase 1 phase 2 trials
4:28
that actually
4:29
when we pick them we make sure they allow
4:31
you know uveal
4:32
melanoma on there because a lot of the trials that are
4:35
offered from the industry they tend to exclude
4:37
most of the uveal melanoma patients
4:40
no that's such a good point okay so if patients
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wanted to learn kind of more about actively
4:44
recruiting clinical trials at The Angeles Clinic
4:47
where would be the best place for them to start to get that information
4:50
so I mean typically what I ask most of my patients
4:53
to sort of access is is reliable sites
4:57
right you don't want um typically
5:00
Google doesn't work so you wanna go to clinical trials
5:03
dot gov website you wanna go to our website
5:06
where it lists all the number of trials
5:08
that we have and their brief description
5:10
whom to contact um and then you know you can
5:14
my email is very very accessible online
5:18
and you can just hit send
5:21
you know an email to me where I can help you decide
5:24
you know if there is something available
5:26
that fits that patient's need versus
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you know I have a number of colleagues within this area
5:32
you know I work closely with Doctor
5:33
Moser work closely with Doctor Chmielowski at UCLA um
5:37
so the three four of us
5:39
you know we partner and and we find
5:42
the need for the patient you know whatever is needed
5:44
for whatever line of therapy that they're at
5:48
we're trying to figure that person out and and help
5:50
sort of you know locate
5:52
that that clinical trial to to get that patient on
5:55
yeah absolutely okay so I love that we just jumped
5:58
right into treatment options so
6:00
the treatment options of clinical trials obviously
6:02
is there and I love that you covered
6:03
you know we've got the neoadjuvant
6:05
the neoadjuvant setting as well as the adjuvant
6:08
and we've talked about those terms
6:10
before so guys if you have questions
6:11
head back to some of those previous
6:12
episodes that we've done um but um what do you have
6:17
like in terms of the current like FDA approved
6:20
treatments that we have specifically
6:21
for uveal melanoma like Hepzato Kit and Kimmtrak
6:24
right so and we'll start with Kimmtrak
6:27
right Kimmtrak's been approved and and I'm pretty
6:29
excited about uh Immunocore actually getting
6:32
ready to present their five year survival data at AACR
6:36
um in about two weeks
6:38
so yeah I think it's coming up super soon exactly
6:41
so I think everybody
6:42
should be tuned in and look at that and this is the therapy option
6:45
available in the first line setting or untreated
6:48
metastatic uveal melanoma patients or unresectable
6:51
uveal melanoma patients um
6:54
who are HLA-A0201 positive I mean we've seen
6:59
the the first line data
7:01
they then they came up with the three year overall survival
7:04
data and now they're gonna update that data
7:06
for five year um
7:07
we know the very typical toxicity
7:09
that tends to happen within the first three weeks very predictable
7:12
for most of the um patients and after that um the
7:16
therapy is very well tolerated
7:18
and their number of patients
7:19
that will actually benefit for a long term
7:22
um so that option is available and
7:24
a lot of the local oncologists actually will
7:28
use our expertise
7:29
to take the patients through the first three doses
7:32
which is the dose escalation
7:35
portion of this treatment and once the patient
7:38
is stable and doing
7:39
well then we return them to the treating
7:41
oncologist or referring oncologist and they
7:43
continue the therapy locally so
7:45
they're not bound to come to us on on
7:47
weekly basis you know they could be at home
7:50
and and visit their oncologist that's within 15
7:53
20 minutes hopefully so I think that's a really
7:56
interesting option that we're able to offer
7:58
um and then obviously in center of care setting
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we also have the expertise
8:03
and the experts available to take patients through
8:06
um the the hepatic perfusion therapy PHP from Delcath
8:12
and we also are applying
8:14
the early phase data from Chopin which is um
8:18
xus trial looking at combination of Ipi Nivo with um
8:23
PHP showed remarkable responses
8:27
a very good overall survival at one year um
8:31
so I think that did is very exciting
8:32
and and Delcath is looking at to to sort of expand
8:35
onto that so I'm actually very fan of that trial
8:40
granted there's a
8:41
significant amount of toxicity that we have to mitigate
8:43
but again
8:45
something that everybody's very excited about
8:48
yeah so
8:50
can I ask you about the toxicity so
8:53
I know that especially in the uveal
8:54
melanoma world I mean I've been a patient
8:56
for coming up on six years and I have
8:59
heard about Ipi Nivo basically
9:00
from within the first few months of my diagnosis
9:02
is like oh my gosh avoid it at all costs um
9:06
as an oncologist what would you say especially
9:08
given the Chopin protocol you know about managing
9:10
the toxicity because I think the
9:12
important thing is that it is manageable
9:14
absolutely I think when we were young in Ipi Nivo
9:18
space right about 10 years ago we didn't know
9:23
how to recognize these immune mediated adverse events
9:27
and a lot of the time we chalked it up to infection
9:30
or this and that and we weren't apt at recognizing
9:35
that these are actually immune
9:36
mediated toxicity and and now we're relatively
9:40
older in that Ipi Nivo space we know how to recognize
9:46
these toxicity and we know how to manage
9:48
them and we're finding
9:49
newer agents to mitigate those toxicity uh for example
9:54
you know a lot of the patients one of the most common
9:56
toxicity from Ipi Nivo is Pruritus or Dermatitis right
10:00
we'll try topical steroids we'll try low dose
10:04
oral prednisone
10:05
we'll try if none of those are working we'll try
10:07
Claritin will
10:08
you know number of different options that
10:10
that are at disposable that are
10:14
easy to take not a lot of side effects but
10:18
there's a small group of patients that still
10:20
can't be managed from that perspective their pruritus
10:23
still bugs them they they can't sleep at night
10:26
the newer agents actually are helping
10:30
um like dupixent you know we'll
10:32
get the dermatologist to use it for that and very effective and
10:36
so it's I'm just trying to say that we are getting
10:40
much better
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at managing those toxicities not just recognizing them
10:44
so when I hear avoid Ipi Nivo at all cost I think
10:50
for some patients if that's the only option
10:53
you should not be thinking that I want to avoid
10:56
Ipi Nivo
10:58
yeah absolutely
10:59
and that's even a bigger story in cutaneous
11:01
melanoma but we'll keep that on one side
11:04
yeah absolutely okay so
11:06
I love that that we can cover
11:08
you know some of these options
11:09
and I know you mentioned the Chopin protocol
11:11
those of you guys listening
11:12
if you didn't tune in to the liver um or the
11:15
I guess the Chopin webinar that we covered
11:17
the Chopin protocol and the trial data
11:19
please go back and listen to that it's gonna give you so much hope but um
11:22
like Doctor Mehmi said
11:24
I mean the data in this trial was astounding
11:27
um for lack of a better term
11:28
and and it really just showed that
11:31
there's a lot of power in combining
11:32
the immunotherapy with Hepzato um
11:35
are you seeing you know like
11:37
have have you been using that protocol in practice
11:39
or is it like only a trial
11:41
I think that's kind of a question some patients have
11:43
I I think it is a
11:45
we've tried it for a couple of patients
11:48
granted it's a small um
11:50
subset of of patients that underwent there are few
11:54
questions
11:54
around the trial as well and how disease was evaluated
11:58
um extrahepatic disease versus intrahepatic disease
12:02
I think there are some questions
12:02
but the data is still very valuable and
12:07
because of the toxicity issues
12:10
both from Ipi Nivo and from hepatic perfusion it
12:14
you gotta select these patients very carefully right um
12:19
because PHP will lead to certain degree of you know
12:23
bone marrow suppression or cytopenias um
12:27
and on top of that you know some GI toxicity
12:30
nausea vomiting and what not
12:32
fatigue weight loss appetite changes
12:34
and some of that can overlap with Ipi Nivo
12:37
and you want somebody
12:40
who can tolerate
12:42
that sort of added on toxicity so
12:44
we're very careful in in selecting these patients
12:47
for that combo approach but yeah definitely
12:49
something we've done it here and and look for patients
12:52
who are who are excellent candidates for that
12:55
awesome okay so we've covered clinical trials
12:57
we have our FDA approved like uveal
13:00
melanoma specific treatment options
13:03
do you guys have other liver directed options
13:05
um systemic options that you offer to patients kind of
13:08
in lieu of trials if things are not recruiting
13:11
or you know if it's just a better
13:12
situation for that patient
13:14
um what other options do you guys have
13:16
so we work very closely
13:17
with two groups of interventional radiologists
13:21
uh here at Cedar Sinai um
13:23
the Medical Center in Beverly Hills
13:25
and Providence Saint John's and both sets of
13:29
international radiology uh and radiation uh
13:31
radiologists are very good at helping
13:34
us out getting the patients in quite quickly for any
13:37
sort of sort of liver directed therapy
13:39
um either you know
13:41
ablation of any sort cold hot ethanolamine
13:46
and also a chemo embolization
13:49
you know all those procedures are still available and at our disposal
13:53
um and we
13:53
continue to use them for the appropriate patients
13:56
um in addition to that you know
13:58
for some of the patients if
14:00
we're kind of running
14:01
against the wall and nothing's available we'll
14:04
rely on the the old faithfuls like Temodars
14:07
or Dacarbazines and things like that for
14:09
kind of like extend
14:10
whatever time we can for our patients yeah absolutely
14:14
so I've actually never heard those terms you said
14:16
Temodars and
14:18
I'm gonna have I'm gonna let you say it again
14:20
Temozolomide or Temodar it's an oral uh
14:23
chemotherapy that's given
14:25
for about five days out of the 28 days and
14:29
has about 20 to 30% response rate not very
14:32
durable but for patients who don't have much options
14:36
we tend to use those off you know that particular the
14:39
the Dacarbazine
14:40
or DTIC is the IV formulation of the same drug
14:44
um you know efficacy is very similar adverse
14:47
event profile is very similar to Temodar
14:49
but again for patients whom I cannot
14:52
find a clinical trial for or they're not a candidate
14:55
um and we've run out of other options you know we
14:59
we fall back onto the old
15:00
chemotherapy and trying to help those patients
15:03
okay so it sounds like overall you and your oncology
15:06
team at the Angeles Clinic have focused
15:08
pretty heavily on expanding the uveal
15:10
melanoma oncology care program um within your region
15:13
so why do you feel like this is particularly
15:15
important for where we live in the states
15:17
like I know I'm in Arizona so like I'm also in the west
15:20
no I I think uveal melanoma is still I mean
15:25
it's a disease that we need to learn a lot about
15:28
you know once we know more about it then we can find
15:31
options to treat it so what I would say is um
15:36
I think
15:38
for any medical oncologists
15:39
that are out in the community um or any patients
15:43
that are diagnosed with this particular disease
15:45
I think we need to get them seen at a high volume
15:49
center to increase the fund of knowledge and also
15:54
sort of have these treatment options
15:56
made available to them
15:58
not a lot of these clinical trials are available
16:00
at every site or every
16:02
you know different place because
16:04
uveal melanoma is such a rare disease
16:06
it is hard for all clinics to invest into it
16:11
they cannot
16:13
um sort of a designated resource for this small
16:17
subset of patient and so that's why
16:19
you know we work closely with UCLA USC um and also UCSD
16:27
and
16:27
UCSF for example like all of us we get on calls every
16:32
you know once a month on a Monday
16:34
at noon time and we go through
16:37
some of the trials that are available at each sites
16:39
and and and we talk about how to kind of
16:42
have these patients get access to these trials
16:46
and I think that that sense of community in a small um
16:50
area it's small by you know from my sort of um
16:56
area perspective with large population um
16:59
and we're just trying to make sure that every patient
17:02
has appropriate
17:03
access to these clinical trials so they can
17:05
reap the benefit of it and and we can
17:07
continue to learn and and have answer to this disease
17:10
that still is fairly difficult to treat yeah absolutely
17:15
so kind of
17:18
jumping off that idea of um
17:21
like why we want to have treatment options
17:23
available especially in the region um I know
17:26
it's always kind of heartbreaking to me sometimes
17:28
when patients
17:28
are telling me like oh well I only can go to the East Coast and I'm like no you
17:32
you have so many other options so
17:34
this is part of why I love chatting with the doctors
17:35
who are at centers like The Angeles
17:38
Clinic and I have done you know a lot obviously
17:40
with my doctor Doctor Justin Moser because
17:42
we want patients to understand there are
17:44
treating medical uh
17:46
uveal melanoma medical oncologists
17:47
who have expertise in the area um I think it's really
17:51
important to distinguish the fact that somebody
17:53
who has this kind of clinical trial awareness who's
17:56
involved in the research
17:57
who's collaborating with other doctors
17:59
across the country like those are the doctors that are
18:02
um going to be best
18:04
for a uveal melanoma patient versus
18:06
like just the oncologist who happens to
18:09
have a uveal melanoma patient
18:11
but like maybe they've never treated one before
18:13
they've never even heard of the cancer before um
18:15
so do you feel like it's particularly
18:17
important to make sure that even if you live kind of out of the way
18:20
you know a couple hours
18:22
that as a patient that we seek care from a
18:24
medical oncologist who has more expertise in the field
18:28
absolutely you know coming through my training
18:31
my you know attendings used to say that
18:34
if you you'll see maybe one uveal melanoma a year
18:37
just to let you know that this disease exists
18:40
but if you three or four then you're an expert now
18:44
and and I think
18:45
there's some truth to that because this is such a rare
18:47
disease that you know a lot of the time
18:52
you know a liver biopsy comes back as uveal as melanoma
18:56
right and so and we know that the treatment options
19:01
for cutaneous melanoma don't really benefit
19:04
the uveal melanoma patients a whole lot so
19:08
it is important to have
19:11
a patient who is suspected for you know metastatic
19:14
uveal melanoma to have them talk to a a
19:17
a provider and a medical
19:18
oncologist who's seen a number of cases you know Doctor
19:21
Moser is a great example for that
19:23
a doctor Chmielowski myself you know um
19:27
so and we've seen various presentations we know
19:31
you know what the
19:33
the different nuances of treatments are and and
19:37
you know how to recognize
19:39
the adverse events that come from Kimmtrak or
19:43
hepatic perfusion
19:44
you know all those things so I think it it just
19:47
helps even if the patient remains with their
19:51
original treating
19:52
oncologist that having a conversation with an expert
19:55
will only benefit the patient you know yeah absolutely
19:59
I think that's for both the community
20:01
oncologist and for the patients
20:04
yeah I think it's so important
20:06
um and I feel like I've talked about this from like day one when I first like
20:09
bribed Doctor
20:10
Moser to come on the podcast with me like
20:12
probably four or five years ago um so I think another
20:17
kind of misconception or kind of commonly held belief
20:20
that I think
20:21
that the community at large of of ocular melanoma
20:24
patients is maybe kind of holding on to um is this
20:27
idea that we don't have
20:29
very many good standard of care options
20:31
for metastatic disease
20:32
do you agree with this or do you believe differently
20:35
given the emergence of like Kimmtrak Hepzato Kit
20:39
I think we're still in the middle of that
20:42
I don't I don't think I mean when you're looking at um
20:46
its counterpart
20:47
cutaneous melanoma right we're we're boasting about
20:51
five year survival ten year survival off treatment
20:55
you know patients
20:56
not getting treated at all and all those things
20:59
we're not there with uveal melanoma
21:01
not at all so I think we're sort of in in in the early
21:05
stages of getting there but we will get there
21:09
but I don't want you know uveal
21:12
melanoma patients to think that there are not
21:14
good options for them you know we have options
21:17
we had I'm I we just stopped you know
21:21
talked a few minutes ago that
21:24
immunocore is updating
21:25
their five year overall survival data with Kimmtrak
21:28
and and it
21:31
well how long did it take us to get there years
21:35
right we didn't talk about five year survival um
21:38
about any FDA approved options for uveal
21:41
melanoma and now we're talking about so we're
21:43
you know taking those small steps
21:45
but they're definitely
21:47
in the positive directions and then we have
21:49
PHP we have Ipi Nivo for some of these patients
21:52
and then Replimune's doing
21:54
amazing work with RP2 and Nivo together um
21:59
Immatics is on its way to establish amazing data
22:03
uh for some of the HLA positive patients
22:05
uh with their um uh adoptive uh t cell therapy
22:10
so I mean there
22:11
and on top of that there are a number of other early
22:14
phase clinical trials looking at you know targeting
22:17
PI3 kinase pathway in uveal melanoma
22:21
and some of the antibody drug conjugate options
22:24
are coming up in in trial options so I mean
22:28
I don't think
22:30
that a patient
22:31
should leave with the thought that they're not
22:34
you know adequate options for them I think
22:37
there are FDA approved options
22:39
and on top of that we have a number of different clinical trial options
22:43
that just gives me hope
22:46
every single day that we are gonna turn the tide
22:49
against this disease
22:50
and that that's gonna happen relatively soon
22:54
yeah I think it's absolutely incredible
22:56
and it's so neat to like I think to be at a clinic
23:00
where you know you guys are a treating clinic
23:02
as well as a research clinic is what I'm hearing
23:04
from kind of the title and what you talked about
23:06
so is there an area of research in uveal
23:09
melanoma that you're most
23:10
excited to currently explore or that you're like
23:12
excited to explore in the future right so
23:15
we're always looking at some of the retrospective data
23:18
looking at you know
23:19
who's really getting helped from these therapies and
23:22
let it be Kimmtrak or other and we've been part of
23:25
number of that those projects and looking at
23:27
you know is Kimmtrak combining with another option
23:30
able to help us more than just Kimmtrak
23:32
alone and granted
23:33
all that is retrospective but it's a signal
23:35
that we can expand on later
23:37
um and always looking at newer treatment options from
23:41
you know looking at patients um tumor genomic
23:44
see if there are any mistakes that we can harness the
23:46
power you know for for treatment options um
23:50
so all the biomarker data is it
23:51
peaks my interest at all times and we
23:53
continue to look at that yeah absolutely
23:56
okay well I feel like this has been such a neat conversation
23:59
we've covered a lot you guys so if you need to go back and listen
24:01
please just you know rewind
24:03
the button on the YouTube channel or on the podcast
24:05
you guys can go back and listen uh but for patients
24:07
who are looking to get in touch or just are
24:10
curious more about The Angeles Clinic um
24:12
you mentioned your email so do you wanna go ahead and
24:15
and share what that email is and then also maybe we can just drop a an info
24:19
blurb in the description below absolutely
24:21
so my email address is
24:23
IMehmi@TheAngelesClinic.org
24:31
you're more than welcome to share my information that
24:34
has in the email the the email address is there
24:37
and our clinic phone number is (310) 231 - 2176
24:42
we're able to accommodate quick appointments
24:44
to help you out so look forward to to working with
24:48
the Danet on this topic
24:49
and continue to help our patients yeah absolutely
24:53
okay last question if patients
24:54
are looking to come that direction
24:57
do you guys have the ability to do telehealth appointments
25:00
yes so you know the the landscape
25:04
of coverage and all that stuff is changing
25:06
but at the same time I continue to do um video visits
25:11
um with with our patients
25:12
who can't travel or or or who are from much further
25:15
away to at least if they need a second opinion
25:17
or to just look over their records to see
25:20
if the treatment steps
25:21
that they're on are appropriate
25:23
or something different we could do or
25:25
in the future if I'm able to offer
25:27
them a clinical trial yeah absolutely
25:29
I continue to do tele visits with the patients
25:33
awesome well Doctor Mehmi
25:35
thank you so much for your time today we could not do this without the physicians
25:38
who come on to our podcast to volunteer
25:39
themselves to be like hey like I'm here I'm treating
25:42
patients um but also who just share your expertise
25:44
and your compassion that you have for patients uh
25:47
we like as a community we really
25:49
I mean none of us would be here without you guys so we're really grateful to you
25:52
thank you
25:54
um
25:54
I just want to also drop a big thanks to our sponsors
25:57
we have sponsors
25:57
for the Eye Believe Podcast and our YouTube channel
26:00
Delcath Systems Ideaya Biosciences
26:02
Castle Biosciences and Aura Biosciences
26:05
you guys our sponsors make this possible they um
26:07
they do a lot to help make sure that we are supported
26:10
as um as a company as a non profit
26:12
who is you know really trying our best to empower
26:14
patients and um continue leading
26:17
the leading the community I think in the education
26:20
of patients
26:20
and making sure we stay on top of things so um
26:22
thanks for being here you guys
26:24
thank you again to our sponsors and Doctor Mehmi
26:25
I would look forward to you know having you back
26:27
again we can chat about something else
26:29
thank you Danet take care