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

At the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Dan Gombos, MD, FACS, of MD Anderson Cancer Center, sat down with Oncology Data Advisor to discuss the field of ocular oncology, the management of tumors that start in or spread to the eye, and the management of toxicity to the eye caused by the treatment of cancer.

This podcast episode was recorded live at the 2022 ASCO Annual Meeting in Chicago by Oncology Data Advisor and ConveyMed. 

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. 

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.

Oncology Data Advisor: And how can you treat ocular cancers?

Dr. Gombos: So, here's the thing: an ophthalmic oncologist has to be an integral part of the team. The best outcomes we get in cancer are when we get good multidisciplinary care. I'm so fortunate to work at a place where every single team member is in their own way an oncologist—from the pathologist, to the radiologist, to the surgeon, to the medical oncologist, to the radiation therapist—we're all specialists in our own way. We all understand our own discipline. When you do have cancer that spreads to the eye, the best approach is a multidisciplinary one. We call each other up. We say, "Well, what is the patient's cancer outside of the eye? Is it limited to the eye? Is it involving the brain? Is it involving other structures? Are they doing well with current therapy? Have they previously been treated with radiation? Where's the big picture?"

Then we create a personalized approach to that patient. For someone with breast cancer in the eye, one patient may get radiation. Another patient may get laser therapy. Another patient may get targeted therapy that's working in the eye. So there isn't one approach. But the beauty, and one of the things I love about oncology, is it's all these smart people coming together for the care of that one person. It's truly what personalized medicine is, and it's the future and the standard of care, as far as I'm concerned.

Oncology Data Advisor: That sounds fantastic. Thank you so much.

Thank you for listening to this podcast recorded live at the 2022 ASCO Annual Meeting by Oncology Data Advisor and ConveyMed. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and oncdata.com. Don't forget to follow us on social media for news, exclusive interviews, and more.

About Dr. Gombos

Dan S. Gombos, MD, FACS, is Professor and Chief of the Section of Ophthalmology at University of Texas MD Anderson Cancer Center in Houston, Texas, with joint appointments at the Baylor College of Medicine and the University of Texas Medical Branch. He is the President of the International Society of Ocular Oncology and founding member and Clinical Co-Director of the Retinoblastoma Center of Houston. Dr. Gombos' clinical, surgical, and research focuses on ocular oncology, with particular interests in the management of retinoblastoma, uveal melanoma, intraocular and conjunctival malignancies.

For More Information

American Association of Ophthalmic Oncologists and Pathologists (2022). Available at: http://www.aaoop.org

International Society of Ocular Oncology (2022). Available at: https://www.isoo.org

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor. 


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