A First Chance at a First-Line Treatment
- Steve B
- Apr 5
- 6 min read
As Patty Johnson was on the surgical table, ready to get a cataract removed from her right eye in 2020, her doctor asked her a peculiar question.
“He asked me if I noticed a black spot on my eye,” Johnson said. “It was so small that it didn’t show up on the prior scan.”
After her cataract surgery, Johnson went to get the black spot checked out. A second opinion at the University of Miami resulted in a diagnosis of uveal melanoma, a cancer that originates in the eye.
“I didn’t even know that was a thing,” she said. “I had never heard of it.”
Roughly 4,500 people receive the diagnosis each year. About half of those patients will develop metastatic disease, with 90% of those metastases being solely or predominantly in the liver.
“I had no idea how long it had been there, and I ran through the whole range of emotions,” Johnson said. “I was panicked, scared, and I was taking care of my mother at the time who was living with me. She was my priority.”
Making a Plan
Johnson, who was 58 when she was diagnosed, sought treatment at the University of Miami, where she learned about the high chance of metastasis. She was treated by an ocular oncologist and a medical oncologist who regularly scanned her to determine if the cancer had spread.
Johnson was willing to do whatever it took to get the right treatment.
It did eventually spread to her liver, but with a liver resection in late December 2022, Johnson and her doctors stayed ahead of it.
“The procedure hurt, of course, but I’ve never felt any pain in my eye from the cancer itself,” Johnson said.
Although she lost a bit of her center vision, radiation flattened the cancer and prevented it from impacting her vision further. However, the cancer did spread again and returned to her liver in February 2024.
Johnson was willing to do whatever it took to get the right treatment.
“I’m still working. I have grandkids, and God is watching over me,” she said. “I don’t consider myself a cancer patient. I have cancer, but I have other things to do!”
Her care team at the University of Miami told her about a treatment option for her second liver metastasis and suggested she travel to Moffitt Cancer Center in Tampa for a newly FDA-approved procedure. Moffitt was just across the state from her home in Deltona on Florida’s east coast. Johnson was all in.
‘A Breakthrough Therapy’
Jonathan Zager, MD, a surgical oncologist at Moffitt, first treated Johnson in late May 2024 with the newly FDA-approved HEPZATO KIT for percutaneous hepatic perfusion (PHP). This procedure uses a series of catheters and balloons to isolate the liver from the body’s circulatory system, allowing for high-dose chemotherapy to be delivered directly to the liver only. The blood is collected as it exits the liver and filtered outside the body via a bypass circuit to remove any remaining chemotherapy. Patients can receive percutaneous hepatic perfusion up to six times, usually performed six to eight weeks apart.
“Uveal melanoma is difficult to treat,” said Zager, the global lead investigator for the FOCUS Phase 3 trial for the procedure. “Percutaneous hepatic perfusion with HEPZATO KIT represents an option for patients that is well tolerated and works. The clinical trial was successful. This is a great new option for patients with this disease. This has been incorporated into our standard of care regimen for these patients. It’s very exciting.”
Zager is working with cancer centers around the U.S. to train others on the procedure to make it more readily available for patients across the country. He said it proved better than the best alternative care therapies available at the time the trial was conducted.
“We should convince the community to use this treatment in first line, as there is data to support treating patients with low burden of disease and as first line will give them the best chance at a response,” Zager said. “This is a breakthrough therapy that will help a patient population that has very few treatment options.”
New Treatment, New Hospital
When Johnson realized that she would be continuing her treatment at Moffitt, rather than the familiar surroundings of the University of Miami, she was nervous. But she knew Moffitt was the best place for her to be.
“It’s scary going from one hospital to another because the people at the hospital are your people, they look after you and they know you,” she said. “I was used to the staff at Miami. But I can say the people at Moffitt jumped right in and have been awesome from the beginning. They are there to answer questions and explain to you exactly what you can expect. I knew I was in good care.”
Johnson also had the support and prayers of family and friends, who kept her company and looked out for her well-being during the trip to Tampa as well as throughout her 36-hour stay at Moffitt after her first procedure in May.
“They put you under general anesthesia, and I was more than happy with that,” Johnson said. “I remember family and friends going to bat for me and helping me recoup. I’m very blessed to have so much support.”
While no one wants to hear they have cancer, Johnson said she was lucky that her cataract surgeon found her uveal melanoma when he did. It was unexpected, of course, but discovering it early made her a stronger candidate for treatment that wasn’t even commercially available when she was first diagnosed.
“It’s interesting, when I had the liver resection, PHP wasn’t available,” Johnson said. “Had we not stopped it then and it had taken over more of my liver, there is a chance I wouldn’t have been a candidate for it today. I believe God played a part in that.”
Johnson had her second percutaneous hepatic perfusion procedure at Moffitt in July and is hopeful that it will keep her healthy for a long time. She’s also focused on keeping a positive outlook, which she believes is key to her recovery.
“It’s really about attitude,” she said. “You have to get in the place in your head where you tell yourself, ‘We’re going to do this.’ Then you just go forward, and you get it done.”
A Growing First-Line Treatment
Johnson used percutaneous hepatic perfusion as a first-line therapy for her metastatic uveal melanoma that had spread to her liver. Although the procedure has shown good response rates in patients who have failed prior therapies, Zager notes that the treatment is still best if it is administered first. If it is unsuccessful as a first-line treatment, patients can move on to other systemic therapies.
“If we don’t use PHP early in the treatment, there could be a chance the patient becomes ineligible for PHP due to progression in the liver or progression to numerous sites outside the liver that cannot be treated between PHPs,” Zager said.
Surgical oncologist Jonathan Zager, MD, is working with cancer centers across the U.S. to train others on the procedure to make it more readily available for patients.
Percutaneous hepatic perfusion has already been incorporated into the standard-of-care regimen for patients with metastatic uveal melanoma since the FDA approved the HEPZATO KIT in August 2023. However, Moffitt is only one of about a dozen institutions treating patients commercially in the U.S. The cancer center has performed percutaneous hepatic perfusion almost 300 times through trials and now as standard of care, with about 20 cases performed since commercial availability in early January 2024.
It’s a start, but not enough, Zager said.
“Our goal is getting more and more people using this type of treatment,” he said. “We have patients coming to us from across the country on a daily basis.”
Johnson said she feels lucky. Not only because her metastasis was caught early, but because Moffitt is within driving distance of her home in Deltona.
“I’m getting this treatment at an earlier stage than some others, and I know that early treatment and early diagnosis is key,” she said. “Dr. Zager and his team really listen, and that brings me a lot of comfort. They listen at all stages of treatment so they can give you effective care and increase your knowledge.”
Johnson doesn’t know what the future holds, but she’s confident that she has done what she needs to do to stay healthy and spend time with her children and her grandchildren.
And she says even long after she’s gone, she’s already told her family that she’ll be keeping an eye on them:
“I tell my kids that after I go, I’ll be the easiest star to see in the sky because I’m going to glow from all of the CT scans and MRIs that I’ve had.”
This article originally appeared in Moffitt’s Momentum magazine.
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