Discovering the Field of Ocular Oncology with Dan Gombos, MD, FACS

Oncology Data Advisor: Welcome to Oncology Data Advisor. I'm Beth Heller and I'm at the ASCO 2022 Annual Meeting with Dr. Gombos. How are you today? And what are you doing at ASCO?

Dan Gombos, MD, FACS: I'm doing great. ASCO is really the preeminent meeting for people who practice medical oncology. My world is a little bit different because I'm an ocular oncologist.

Oncology Data Advisor: You are the first ocular oncologist I've ever met.

Dr. Gombos: Well, ocular oncology is a very small, subspecialized area, but it's very well recognized. We are primarily individuals who train as ophthalmologists or eye care specialists, but then we do specialty training in eye cancers.

I serve as Chief of Ophthalmology at MD Anderson Cancer Center in Houston, Texas. I've been there for over 20 years. We manage primary cancers that start in the eye. People don't realize that cancers can actually develop within the eye. Cancers can also spread to the eye.

Increasingly, our field is dealing with the toxicities that these great agents that are curing cancer patients cause; we are dealing with eye problems, eye toxicities, and side effects from these targeted agents. A meeting like this is really an opportunity for someone like me who's not a medical oncologist but has to deal with all these agents. We're very heavily based in clinical trials at Anderson and support those patients as they go through their clinical trials.

It is a very niche area, but we have societies. We have the American Association of Ophthalmic Oncologists and Pathologists. We have the International Society of Ocular Oncology. I'm currently its president. We're increasingly an integral part of the cancer solution. I don't think, moving forward, that you can be a great tertiary care center without integrated ophthalmology. That is definitely the future of the field.

Oncology Data Advisor: How often does cancer spread to the eye?

Dr. Gombos: It doesn't spread routinely, but there are certain cancers that clearly have a predisposition. Breast and lung are the most common cancers that can spread to the eye. What we see increasingly is that there have been so many successes with cancer management for advanced cancer, but some of these agents don't get along with the ocular system. We will sometimes see active cancers that we didn't years ago, because the patients are surviving. They're making it to these incredible years of survival, but that also lends itself to structures that historically were less involved becoming involved. We are asked to treat those areas.

Oncology Data Advisor: So how do patients know if the cancer has spread to their eye?

Dr. Gombos: That is a great question and one that I get asked all the time. It's often a misconception that cancer in the eye is painful. People assume that cancer is going to be painful. It could be completely asymptomatic, but often it's blurry vision, distortion of vision. Sometimes it can be flashing lights. With some of the newer drugs, we're noticing inflammatory problems. It causes uveitis or inflammation of the eye. Some other drugs are causing swelling of the cornea, but spread to the eye is usually in the form of invasion to the vascular layer of the eye. We call that the choroid, and that usually is associated with either no symptoms, or blurry vision or flashing lights, similar to what you would expect with a retinal detachment.

Increasingly, there are agents now where the standard of care is to get an eye exam. The FDA is now requiring eye exams with some drugs, when the medical oncologist is prescribing that medication. You need an eye exam to monitor and make sure you're not developing toxicity.