Making history: St. Luke’s conducts first-ever successful intra-arterial chemotherapy to eye cancer patient

Growing up, it may be common to hear our parents and relatives remind us to take care of our eyes. However, there are instances wherein care and nutrition are not enough.

An example of this is when children are afflicted with retinoblastoma, a cancerous disease wherein a malignant tumor grows in one (unilateral) or both (bilateral) eyes. It is considered a genetic disease, caused by a mutation in the child’s genes. Similar to other cancers, retinoblastoma is due to abnormal cell growth, particularly in the tissues of the retina.

Retinoblastoma is a dangerous disease that commonly affects children aged 0-5 years old. Children who are afflicted with late-stage retinoblastoma may suffer from blindness and can metastasize into other parts of the body, most commonly the brain.

Last February 16, 2022—St. Luke’s Medical Center (SLMC) made history as the first-ever hospital in the Philippines to successfully conduct and complete intra-arterial chemotherapy (IAC) to a three-year old patient suffering from late-stage retinoblastoma.
 

“Retinoblastoma is a deadly disease if not treated immediately. While survival rates are high (90%) in developed countries, it is less than 50% in the Philippines. This is due to late detection and the limited number of specialists who have experience in treating this disease,” said Dr. Andrei Martin, the attending physician of the patient, and one of only a handful of ocular oncologists in the Philippines.

Dr. Martin’s patient, a three-year old male child, is already in Group E of bilateral retinoblastoma. Grouped as ABCDE, stage E is the most severe stage of the disease. Due to the severity of the disease, the child’s other eye has been removed to prevent it from worsening.
 

“His parents have been consulting with us for the past one and a half years to treat the child. We have tried a range of treatments, such as systemic chemotherapy, to control the tumor, but with little success.” Dr. Martin said.

“It even reached a point where other services recommended to stop the systemic chemotherapy due to the side effects. Instead, we recommended removing the affected eye. However, the child’s parents were against it, and understandably so, since this is now his only remaining eye.” Dr. Martin added.

Running out of options, Dr. Martin reached out to several SLMC doctors to form a team to administer intra-arterial chemotherapy or IAC. IAC is a form of chemotherapy delivered via intravascular microcatheter that administers medicine directly to the patient’s eye through the ophthalmic artery.

“IAC involves infusing the chemotherapeutic agent into a specific artery, which in this case is the ophthalmic artery. Since the treatment is being infused into a specific area, the rest of the body is spared of side effects that are usually associated with systemic intravenous chemotherapy,” Dr. Martin said.
 

The IAC procedure can take anywhere between 45 minutes to three hours, depending on the time spent locating the ophthalmic artery. For this patient, the ophthalmic artery was not in its usual position, adding another challenge in the treatment.
 

Post-treatment, the pediatric patient is recovering well. According to Dr. Martin, the patient’s mother said that her child was behaving as if nothing happened, noting the child’s high energy and playfulness.
 

However, due to the child’s late-stage retinoblastoma, there is still work to be done.
 

“The next step for us will be to monitor the child, such as checking for signs of excessive bleeding in the incision area where the catheter was inserted and
to monitor the response of the tumor to the intra-arterial chemotherapy. Research also shows that the success rate of IAC is maximized after three sessions, so he would need to undergo two more sessions of IAC,” Dr. Martin said.
 

Dr. Benjamin S.A. Campomanes, Jr., SLMC’s Executive Vice-President and Chief Medical Officer, attributes this historical success to SLMC’s cast of highly-trained doctors who made diagnosis and treatment possible.
 

Dr. Dennis Villanueva (left) specializes in pediatric interventional radiology and has experience in administering IAC in Vietnam. Dr. Andrei Martin (right) spent a year at Wills Eye Hospital in Philadelphia, USA to train under the world’s best ophthalmologists and ocular oncologists.

“The IAC procedure was made possible due to the valuable expertise of Dr. Andrei Martin as our ocular oncologist and the Interventional Radiology Team led by Dr. Dennis Villanueva and Dr. Angelito Tingcungco,” said Dr. Campomanes, Jr.
 

“To complete the team, the procedure also involved the expertise of Dr. Allan Gamo (Anesthesiology-Pediatric Anesthesia) and Dr. Luz Del Rosario (Pediatric Hematology-Oncology),” Dr. Campomanes, Jr. added.

The hospital’s readiness in its facilities and technology also ensured the procedure was a success.

With the first successful IAC procedure done, Dr. Martin and his team hopes to encourage more parents to consider IAC treatment at St. Luke’s for children with retinoblastoma.

"We aim for the Eye Institute of SLMC to become a referral center for patients with eye cancer. To achieve this, it is important for us to raise awareness about eye cancer to parents, especially the importance of early detection of the tumor,” said Dr. Martin.

“There may be cases wherein a child will complain of poor eyesight or parents may notice misalignment of the eyes or a white discoloration of the pupil. While this may look benign at first, there is a risk that these are signs of a severe eye disease such as retinoblastoma,” he said.

“We advise all parents to have their child regularly checked by their pediatrician. If your child has any eye problems, it is always recommended to have it examined right away. The best time to treat a disease is now, and not later,” Dr. Martin concluded.

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