International Multicenter Cooperative Study Supported by The Eye Cancer Foundation

 

The American Joint Committee on Cancer (AJCC) Cancer Staging Manual compiles all currently available knowledge on cancer staging at various anatomic sites. In 2016, they released the 8th edition, conjunctival melanoma staging system which features 12 new staging systems, a wide range of new staging definitions, and an emphasis on the personalized-medicine approach. This staging system is used and respected by medical, ophthalmic, and radiation oncologists because it standardizes data reporting, prognosis, and selection of the best treatment for conjunctival melanoma. Nonetheless, a collaborative multicenter international registry was organized by our very own Dr. Finger to evaluate the accuracy of such a staging system. In addition to the 19 co-authors listed, Dr. Puneet Jain led the analysis, writing and collaborative revision of this study. He completed an Eye Cancer Foundation-sponsored Fellowship. ECF fellowships are known to foster ophthalmic oncology training, curiosity, learning and ability to perform research!

This study, performs the first ever international multicenter study to evaluate the validity of the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual in estimating mortality rates of metastasis from conjunctival melanoma. The 8th edition AJCC ophthalmic oncology staging systems were written by more than 50 eye cancer specialists from 18 countries.

In this study, co-investigators utilized internet-based data sharing, reviewing 288 conjunctival melanoma patient medical histories. This study included data from 10 ophthalmic oncology centers in 9 countries over 4 continents — 2 in the United States and 1 in Canada, Colombia, Argentina, France, Netherlands, United Kingdom, Sweden, and Jordan. Clinical (cT) and pathologic (pT) staging were performed according to the staging system for conjunctival melanoma in the 8th edition of the AJCC Cancer Staging Manual.

This study was able to find new insights by conducting an analysis of large numbers of rare tumors. The findings corroborate the validity of the 8th edition of the AJCC Cancer Staging Manual. However, it also found several independent factors that are associated with increased mortality, such as tumor thickness, tumor invasion, and ulceration. Ultimately, this study supported the continued use of conjunctival melanoma staging system as published in the 8th edition of the AJCC Cancer Staging Manual.


Eye Cancer Care in Ethiopia

The Eye Cancer Foundation’s “2020 Campaign” claims another country, Ethiopia! We supported intensive training of a local ophthalmologist on advancements in retinoblastoma research, treatment, and diagnosis. Our most recent ECF grant recipient, Dr. Abu Amare, an ophthalmologist in Ethiopia, just completed a  6-month retinoblastoma fellowship at the Rasoole-E-Akram Hospital of The Iranian University of Medical Sciences in Tehran, Iran.

Dr. Amare notes of his experience, “The fellowship program made a big difference in my skill and knowledge in diagnosing retinoblastoma…” He also is grateful for the opportunity to have been able to shadow physicians in different disciplines, such as oculoplastic surgery, learning about enucleation and evisceration — he also observed interventional neuroradiology for intra-arterial chemotherapy and surgeons performing plaque radiotherapy. Dr. Amare was able to connect with his mentors, as they were polite and courteous and took their time to truly teach  him techniques, such as RetCam photography, that he called “profound to the maximum” and with “no limitations.” Further, he was exposed to ophthalmic pathology, including tissue processing and examinations under light microscopy for a variety of eye tumors. These valuable skills for an ophthalmologist specializing in retinoblastoma are necessary for its early diagnosis and treatment.

 

With the help of the ECF, Ethiopia has gained a learned and more knowledgeable ophthalmologist who can help in preventing blindness and retinoblastoma-metastasis within the Ethiopian population. The Foundation has given Dr. Amare the tools necessary to organize the first ever eye cancer center in his home country. On his plan to share what he has learned as a fellow, Dr. Amare says that he would “start with organizing the appropriate instruments and equipment to establish a dedicated team…creation of awareness [about retinoblastoma] ranges from policy makers down to different levels, specialties, and supports.” Such comprehensive training through the fellowship program that the ECF provides will save the sight and lives of thousands of people, for generations to come.

 

We will continue to focus on unserved and underserved countries with little to no eye cancer care. The Eye Cancer Foundation will continue to help Dr. Amare organize his ambitious and driven team, and plans to prevent and cure retinoblastoma in Ethiopia.

 

For more information on The Eye Cancer Foundation and its mission, visit www.eyecancercure.com.

 

To donate and help sponsor more specialty training in unserved and underserved countries, go to www.eyecancercure.com/donate.

 

 


A “Biomarker” for Conjunctival Melanoma

The COMS Study

What causes conjunctival melanoma (CoM)? Because of its rarity, much about CoM is unknown. Current medicine has yet to truly pinpoint any underlying genetic factors affecting CoM. In fact, no molecular drivers have been clearly defined in association with metastasis, recurrence prognosis, cell type, or other characteristic factors of CoM. In response to this gap in literature, a large multi-center study was launched. Over a dozen eye cancer centers collaborated in order to determine biomarkers that may indicate risk for metastasis or tumor growth.

With access to a large sample of nearly 100 patients from eight different eye cancer centers around the world, the researchers behind this study sought to clearly define key biomarkers of CoM metastatic risk, and to correlate these biomarkers to clinical features and outcomes. This association of molecular indicator to clinical feature would ultimately help treatment providers identify patients who are at greater risk for metastasis, and help researchers identify possible molecular targets for therapy.

At the conclusion of this study, it was found that in deletion mutations in a gene region called “chr10” (normally consisting of tumor-suppressing genes) significantly correlated with metastasis, lymphatic invasion, and increasing tumor thickness.

This study was the first to characterize chromosomal copy number alterations (CNAs) in such depth and with such a large and well-defined sample. The result is a more clearly-defined biomarker as a CoM risk factor than there has been in previous literature. The next plan of action with this newfound information, however, would be to apply this and other relevant research in order to further develop more effective therapies and accurate prognosis.

 

Click here for the full-text!

 

 

Check out The Eye Cancer Foundation for more information on the latest eye cancer research, charitable accomplishments, and for more information on how to donate and support new research and education!


Dr. Ann Musika Completes ECF Fellowship

From Uganda to Israel, and Back Home Again

Hailing from Kampala, Uganda, Dr. Ann Musika has completed her 6-month ophthalmic oncology fellowship training sponsored by the Eye Cancer Foundation.

From Left: Dr. Ann Musika, Dr. Alezam, Dr. Didi Fabian, and Dr. Vicktoria Vishnevska-Dai

For the past six months, Dr. Musika has trained at Sheba Medical Centre at the Goldschleger Eye Institute under supervision of the director of the ocular oncology unit, Dr. Vicktoria Dai. Her training included all aspects of eye cancer care––from diagnosis, to treatment, to intravitreal injections for radiation retinopathy. Additionally, she took part in various research studies at Goldschleger’s ophthalmology department.

The Eye Cancer Foundation places an emphasis world-class training as well as practical and applicable training. So while Dr. Musika learned all aspects of eye cancer treatment practiced at Goldschleger’s, she specifically focused on treatments and techniques that would be just as readily available to her in Kampala.

Dr. Ann Musika (second from the left) alongside Senior ocular oncologists (Presenters) with after the ocular oncology training at the University of Sienna Italy on December 6th-7th, 2018

“It is with great pleasure that I express my sincere gratitude

to you for the great support that you offered me…all this wouldn’t have been possible without your generous support. The knowledge and skills acquired from this training I hope to apply to improve the quality of care for our ocular oncology patients in my nation. I am forever grateful.”

Prior to Dr. Musika, there were no fellowship-trained eye cancer specialists in Uganda. Consequently, patients with eye cancer suffered not only from their disease, but also from a lack of specialized care. However, now upon the completion of her training, Dr. Musika intends to return to Uganda and provide her nation with much-needed specialty care.

 

To Learn More about the Eye Cancer Foundation, its mission, and fellowship opportunities, visit the website at www.eyecancercure.com.


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.


The ECF Establishes the First Eye Pathologist in Jordan

Prior to involvement of The Eye Cancer Foundation (ECF), Jordan had no practicing eye cancer specialists. We trained Dr. Yacoub Yousef and he established the first eye cancer referral center at The King Hussein Cancer Center in Amman. After years of building this center, Dr. Yousef has trained many eye cancer specialists for the surrounding countries and has offered life and vision-sparing treatments for patients throughout the Middle East. Finally, with a place to go, patients requiring eye treatment inundated these hospitals. With more and more patients needing eye cancer services, Jordan and the Middle East needed a specialist in eye pathology.

In response to this need, The ECF supported Dr. Jakub Khzouz’s fellowship in ophthalmic pathology and oncology with Dr. Sarah Coupland at the Royal Liverpool Hospital in Liverpool, England. Dr. Khzouz has so far spent one year learning modern methods of ophthalmic pathology (adult and pediatric), as well as the diagnosis and treatment of eye cancers.  

Dr. Khzouz reports that his exposure to Eye and general Pathology with Dr. Coupland at  Liverpool Hospital’s pathology laboratory was significantly different from his prior experience in Jordan. He learned that eye cancer specimens should be handled by trained eye pathology specialists. “Proper sample grossing and detailed reporting are important for staging and aid management,”says Dr. Khzouz. He intends to reassess prior pathology reports, stating that “once back in Jordan, my first project will be to review all the retinoblastoma cases archived in our pathology laboratory, independently report and stage them according to the latest 8th edition AJCC-TNM system, and then compare that with the original reports.” Such will be important for research purposes, as well as defining the impact and importance of fellowship-training with respect to complicated pathologies.

Our fellows have even greater plans for the future of eye cancer treatment in Jordan. Dr. Khzouz intends topartner with the first eye cancer specialist in Jordan, ECF Fellow Dr. Yacoub Yousef. “I have discussed with my colleague Yacoub, and by working together we will improve the quality of the King Hussein Ocular Tumor Service and reach out to other laboratories and countries to perform molecular and genetic testing for eye cancer patients.”

Through our fellowship programs, The Eye Cancer Foundation has sought to provide unserved and underserved countries with the best quality fellowship education and training from some of the most experienced specialists in the world. We motivate our fellows to bring new techniques and advancements to their home countries so that access to optimal eye cancer treatment becomes universal. We will continue to support our fellows, Dr. Yousef and Dr. Khzouz and now offer Jordan two fellowship-trained eye cancer specialists who are dedicated to saving sight, saving life and “paying it forward” by teaching fellows from other middle eastern countries.

However, our goal is not yet complete. Many more countries are in great need, and we hope to place at least one eye cancer specialist in each country. Click here to donate to our cause.

 


World Cancer Day 2019

For nearly 20 years, the Union for International Cancer Control has brought the world together  in a unified front against cancer. World Cancer Day aims to “unite the cancer community to reduce the global cancer burden, promote greater equity, and integrate cancer control into the world health and development agenda” (worldcancerday.org).

The Eye Cancer Foundation’s goals closely align with those put forth by World Cancer Day. Life-saving diagnostic techniques and treatment methods for cancer should be accessible to everyone throughout the world. This is the exact reason why the ECF has emphasized and supported the placement of fellowship-trained cancer specialists in unserved and underserved countries for the past 20 years. While we continue researching and innovating for more precise treatment, we also want interventions available in order to halt the preventable deaths of children with retinoblastoma and patients with cancers of the eye and orbit.

“We believe that access to life-saving cancer diagnosis, treatment, and care should be equal for all – no matter where you live, what your income, your ethnicity or gender…We believe that individuals, together can create change.” – worldcancerday.org

This coming World Cancer Day, consider supporting and raising awareness for eye cancer, a rare cancer variety in critical need of worldwide acknowledgement.


More about World Cancer Day: https://www.worldcancerday.org/

Donate to the ECF: https://eyecancercure.com/donate


New ECF Graduates Bring Their Skills to Egypt and India

Saving the Underserved in Egypt and India…

We at The Eye Cancer Foundation are pleased to celebrate the graduation of our two most recent recent fellows: Dr. Puneet Jain from India and Dr. Moanes Morkos from Egypt. In traditional ECF manner, both fellows return to their country with goals to care for eye cancer patients, advocate for patients, improve treatment and training. They will present their ECF sponsored research work at eye meetings in their countries and around the world.

Having successfully completed their training, Dr. Jain and Dr. Morkos now join the ranks of over forty fellows trained and sponsored by the ECF. Not only have we reached the goal of our 2020 Campaign––to train 20 eye cancer specialists in 20 unserved and underserved countries by the year 2020––we have doubled it.

With the support of our donors, we have taken on and answered many previously unsolved questions about eye tumor diagnosis and treatment  this year. We hope that this momentum does not decline, but rather accelerate, and bring us to a future where ocular melanoma, retinoblastoma and eye cancer deaths do not exist.

To become a patron, simply give a gift to The Eye Cancer Foundation. You can sponsor fellows like Dr. Jain and Dr. Morkos, buy prosthetic eyes for retinoblastoma children, or aid in any of our numerous goals for a clearer, brighter future.

Next stop: the rest of the world!

Donate Now!


ECF Fellow Presents: How to Save Eyes in Cairo, Egypt

Dr. Abhilasha Maheshwari (above) presents ECF research at Ophthalmic Oncology Meet

November 22nd Cairo, Egypt:

November 22nd Cairo, Egypt: Physician scholars came together for The 2nd Middle East Ophthalmic Oncology & Pediatric Retina Meeting. Organized by Dr. Ihab Othman, the meeting fostered discussion of various topics in ocular oncology.

The Eye Cancer Foundation (ECF) fellow, Dr. Abhilasha Maheshwari, shared recent findings of ECF supported research. She first presented her research with her mentor and ECF-chair Dr. Paul T. Finger. The article, titled Regression Patterns of Choroidal Melanoma After Palladium-103 (103Pd) Plaque Brachytherapy, shows how choroidal melanomas regress after 103Pd plaque radiation therapy.  Initially discovered as effective ocular cancer treatment by Dr. Finger in 1990, 103-Pd ophthalmic plaques have since been scientifically proven to be more gentle and effective than its precursor, 125-I. [See our results after 103Pd plaque therapy for choroidal melanomas on our website!] Results showed the tumors became darker, decreased in thickness, and there was a reduction or complete elimination of the tumor vascularity.

Dr. Maheshwari continued her presentation on choroidal melanoma by discussing patients whose tumors were located very close to the optic nerve. This talk, “A 12-Year Study of Slotted Palladium-103 (103Pd) Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve, discusses how using specially designed plaques created by Dr. Finger, even melanomas that surround the optic nerve can be treated with eye and vision sparing radiation therapy (instead of removing the eye). Dr. Maheshwari’s results showed > 98% tumor control, while most had relative preservation their sight and eye.

The Eye Cancer Foundation takes great pride supporting research that improves patient care. Our fellows are given travel grants to spread the word around the world. As we spread knowledge of these unique findings and improved treatments, we also spread hope for those who would alternatively lose both sight and life.

 


 

To donate to the ECF and help sponsor fellowships, research, and cancer treatments, click here!

Read Dr. Finger and Dr. Chagule’s paper here.

Read Dr. Finger and Dr. Maheshwari’s paper here.


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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