Day 4: Live From the ISOO 2019!

Day 4 at the ISOO: Retinoblastoma

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.

Preventing Retinoblastoma

Dr. Helen Dimaras opened with her talk on clinically preventable retinoblastoma, having analyzed the frequency of unfavorable outcomes such as death, metastasis, enucleation, EBRT, and how we can avoid such outcomes. Looking at data retrospectively allows physicians to “review how patients do and improve practice by looking at the past, reducing errors, and improving documentation and precision of care.”

In high-income nations, frequency of poor outcomes is low, and we need to work on expanding such rates abroad. Not only this, but a comment from the audience emphasized the significance of this study’s call to action: even just one child who succumbs to retinoblastoma is a child lost, and such outcomes need to be taken very seriously. We need to avoid misdiagnosis and under-treatment as much we humanly can to ensure that unfavorable outcomes do not happen in the future.

“Chemoplaques”

Dr. Brenda Gallie presented an interesting study regarding a device named “chemoplaques” in Chemoplaque (sustained-release topotecan episcleral device) for retinoblastoma: Opportunity for rapid clinical evaluation of toxicity and efficacy to support safe eye salvage. The devise works through continuous exposure via diffusion, and has thus far produced promising results. By day 28, most of the studied tumors had gone away, and many were gone even earlier, by day 18.

International Fellowship Training Guidelines

Forming Plans for Future Fellowships

In an auxiliary lecture hall, many of us gathered to discuss training fellows all over the world in order to create and develop international treatment centers that will allow greater access to eye cancer care in underdeveloped countries and underserved areas. Sound familiar? As this is one of the primary missions of The Eye Cancer Foundation, Chairman of the ECF, Dr. Finger gave a lecture and lead the discussion.

Dr. Finger with fellows trained by Dr. Honavar in Hyderabad, India. From left: Dr. Sumeet Lahane, Dr. Paul Finger, Dr. Puneet Jain, Dr. Mrithika Sen, Dr. Ankit Tomar, and Dr.

So what is the plan of action? Flexible fellowships with candidates sent from the ophthalmic society of the unserved or underserved region. Being underserved locations, we must be open to 3-month long fellowships, since the physician is needed in their country to give care. 12-month fellowships oftentimes are unfeasible. We must also make a collaborative effort to increase funding for such programs. Dr. Finger says “It has been my experience that funding can come from unexpected places. All you need to do is discuss this wonderful work we are doing and relate how we need help. It is a blessing to allow others to share in the accomplishment of saving children’s sight and life.”

Full video of Dr. Finger’s Lecture Here!

International Fellowship Training Guidelines Meeting Attendees

 

Day 3: Live From the ISOO 2019!

Day 3 at the ISOO: Melanoma, Other Intraocular Cancers, and Basic Retinoblastoma Science

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.

Dr. Puneet Jain presenting his iris varix poster

Dr. Puneet Jain returned to give us some insight on iris varix by presenting his paper Iris varix: 10-year experience with 28 eyes, published alongside Dr. Paul Finger during his Eye Cancer Foundation fellowship. The study began with the intention to more clearly define iris varix, consistent characteristics, imaging findings, and note any consistent change that might occur with observation. The results showed that iris varix is “primarily located in the inferotemporal quadrant, not associated with dysmorphic pupillary findings, progression, secondary glaucoma, or malignancy.” Essentially, “iris varices were benign vasculopathies with no associated ocular or vision-related morbidity.”

Dr. Ekaterina Semenova’s poster presentation

Why are some cases naturally suppressed by the immune system? Dr. Ekaterina Semenova raised the question, noting five cases in which choroidal melanoma in the patient had spontaneously regressed in her paper Spontaneously Regressed and Apparently Dormant Choroidal Melanomas, also published alongside Dr. Finger. She opened up discussion to the audience, though consensus was that this would be an interesting topic for future research in order to determine the cause. Now that such cases have been documented, we have this data to look back on and, hopefully, make additions to.

Dr. Abhilasha Maheshwari (left) and Dr. Paul Finger (right) after another successful poster presentation!

Finger’s Slotted Plaques was recognized in Dr. Abhilasha Maheshwari presentation, A 12-Year Study of Slotted Eye Plaque Radiation for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve. Over a decade’s worth of data was analyzed and slotted plaques were found to be very effective and resulted in good patient outcomed for patients whose tumor lies close to the optic nerve. These plaques offer more proper positioning of the plaque, allowing radiation to the entire melanoma plus a 2-3 mm margin. Dr. Maheshwari concluded that even after 12 years, “slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.”

That’s all for today’s ECF highlights! Day 4 will be fully dedicated to retinoblastoma. Stay tuned!

 

To help sponsor fellowships and fellow research, donate to The Eye Cancer Foundation at www.eyecancercure.com/donate.

Day 2: Live From the ISOO 2019!

Day 2 at the ISOO: Melanoma Day

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.

How Can You Tell a Choroidal Melanoma is Regressing?

Dr. Abhilasha Maheshwari, ECF fellow

Dr. Abhilasha Maheshwari was the first Eye Cancer Foundation fellow to lecture today with her presentation on the paper Regression Patterns of Choroidal Melanoma after Plaque Brachytherapy, published alongside Dr. Paul T. Finger. In the two-minute rapid-fire session, Dr. Maheshwari filled us in on her data points from the study, concluding that there are various markers that show us when a choroidal melanoma is controlled after treatment with plaque brachytherapy. She provided us various markers, such as:

  • Dr. Finger and Dr. Maheshwari

    Increased tumor pigmentation.

  • Ultrasonography results:
    • maintenance of dome/mushroom shape
    • decreased tumor thickness
    • increased internal reflectivity
  • Fundus autofluorescence imaging showed a pattern of increased followed by decreased organge pigment lipofuscin
  • OCT showed decreased exudative subretinal fluid, and resolved drusenoid retinal pigment epithelial detachments (DRPED)
  • Flurocein angiography showed resolution of intrinsic tumor vascularity

Each of these characteristics serve as indicators of tumor regression. Dr. Maheshwari gave us one final take-away message: better initial local control means extremely less systemic spread, which overall means better patient outcomes.

Dr. Finger and Dr. Maheshwari in the “hot seats” up on stage – Every new session rotates a panel of doctors who have given lectures in order to ask and answer questions and foster discussion.
Interesting New Finding: One talk updated us on recent clinical trials for a drug that showed promise in laboratory studies for reversal of the effect of BAP1-related tumor progression. Perhaps we will hear more on this at the next ISOO!

Unique Case Report: Two, Simultaneous Primary Melanomas

Dr. Maheshwari returned for her second talk of the day, presenting results from Bilateral Simultaneous Primary Choroidal Melanomas: Treated with Palladium-103 Plaque Radiation, published along with Dr. Paul Finger. She elaborated on an interesting case who presented with separate, unrelated choroidal melanomas, one in each eye. After sequential treatment to maximize outcomes, the patient remains at 20/25 vision and shows great outcomes since their latest follow-up.

Unique Case Report: 7 Years After Treatment of a Primary Melanoma, A Second Primary is Found

Dr. Finger gave his first talk of the event to present a unique case of a patient who had been successfully treated for a stage T1 ocular melanoma. Seven years after treatment, however, she developed choroidal metastasis (this one, T3). Following intensive immunotherapy, the patient showed tumor controlled and marked decrease in liver metastasis. Upon follow-up, the patient still sees 20/25 and is maintained with anti-VEGF therapy.

With this talk, Dr. Finger wants to emphasize “the importance of consistent, long-term, post-treatment periodic ophthalmic and systemic surveillance for patients with choroidal melanoma.”

Dr. Finger Presents a Unique Case!

Identifying Genes Associated with Cancer Predisposition

Dr. Colleen Cebulla presented interesting findings in her presentation, Whole exome sequencing to identify candidate genes associated with hereditary predisposition to uveal melanoma. She covered various, possibly cancer-related genes other than the well-known, BAP1 mutation. At the beginning stages of research, the project has already analyzed 29 cases and identified a significantly large incidence of the genes SMARCE1,, PALB2, and MLH1. Particularly of interest are  PALB2, which has already been linked to breast, ovarian, and pancreatic cancer risk, and MLH1, which has been linked to Lynch syndrome and has been deemed responsible for multitudes of different tumors.

Dr. Cebulla is happy to welcome additions to the study and to be contacted if any centers are willing!

“SORTT” for Short: Study of Ophthalmic Radiation Therapy Toxicity 

Unfortunately unable to attend, Dr. Wolfgang Sauerwein requested Dr. Finger to present on Study of Ophthalmic Radiation Therapy Toxicity (SORTT): a prospective international survey. A major talk of the day, SORTT proposes “a prospective, multicenter, international data registry that collects structured information on toxicities after radiotherapy for eye cancer. This will offer the medical evidence needed for ophthalmic radiation side effect staging and modality selection.” This data may also help to create an AI to help physicians select the optimal radiation modality for each individual case.

Another jam-packed session of presentations, lectures, research findings, and plans for greater multicenter cooperation. As Day 2 comes to a close, Day 3 promises more on melanoma, other intraocular cancers, and the beginning of retinoblastoma discussions.

Day 1: Live From the ISOO 2019!

Day 1 at the ISOO: International Collaboration & Eye Cancer Care Worldwide

Every two years, eye cancer specialists worldwide convene at the International Society of Ocular Oncology Conference in order to review latest research and encourage international collaboration within the field of ophthalmic oncology.

For details on the ISOO Biennial Conference, read more here.

International Collaboration

The day began with a few talks instigating discussion on how to approach international, collaborative efforts, and how to improve on how we currently approach international cooperation. How do we get over international boundaries and laws restricting data-sharing, and varying laws surrounding research across countries? Much is yet to be done, though discussion is expected to continue as specialists from all over the world have convened at this conference.

Read on how Dr. Finger encourages international cooperation here.

What Do We Register and Why?

Featured ECF Fellow: Dr. Puneet Jain

Dr. Puneet Jain, on Registering Conjunctival Melanoma
Dr. Paul Finger (left) and ECF fellow Dr. Puneet Jain (right) immediately after his debut lecture.

Registries were a huge topic of discussion today. What is possible to be registered, what details should we include within the registry, how do avoid duplicate cases within separate registries, and how do we apply this to international cooperation? Among other points of discussion, however, it was unanimous that functional registries would assist greatly both with research and patient outcomes. The New York Eye Cancer Center’s recently graduated fellow, Dr. Puneet Jain, spoke particularly on the registering of conjunctival melanoma. His research with Dr. Finger evidenced the accuracy of the AJCC’s TMN classification for predicting metastasis.

 

Developing Worldwide Retinoblastoma Care

Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.
Dr. Brenda Gallie credits the Eye Cancer Foundation for research support.

 

 

 

 

 

 

 

 

 

Dr. Brenda Gallie discussed the development of retinoblastoma care worldwide. She noted the growing importance of genetic testing, stating a case in which laser treatment was sufficient enough to control the disease. She briefly mentioned project DepictRB as a way to display anonymized patient data, and offered the audience a demo of the program.

Conclusion

The day concluded with unanimous agreement that worldwide collaboration within the field of eye cancer needs to continue and needs to improve. With enhanced cooperation and worldwide registries, the

amount of shared data will assist greatly in advancement of research, diagnosis, and patient outcomes.

Tomorrow we cover ocular melanoma in great detail. Stay tuned, out fellows and Dr. Finger will be informing us with their expertise!

ISOO 2019 Day 1 Complete!

Post-Op: High Spirits and Great Outcomes!

Dr. Finger and one of his many happy patients in high spirits, just one week after her plaque removal. Her recent follow-ups show steady progress and her characteristic, amazing positivity! (Here she is with Dr. Finger, and googly-eyes attached to her glasses!!)

This patient, along with all Dr. Finger’s patients who require plaque brachytherapy, received a Palladium-103 plaque. Compared to iodine and ruthenium, palladium offers more targeted treatment, and, as a consequence, yields better results and better outcomes.

Learn more about Palladium vs. Other Radiation Types by reading our brochure: The Importance of Palladium Plaques

Patient Stories

"Very well treated by Dr. Finger. He explained everything I needed to know about my issue with detail and attention, putting me at ease and giving me confidence to handle this problem for the rest of my life.”
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