MADISON, Wis. – Paul Lynch loves to travel so much that he took a part-time job with Delta Air Lines while he considered retiring from a career as a general contractor.
In 2021, he was working as a below-wing agent, assisting with planes arriving and departing at the airport in Minneapolis, when he started to notice issues with his vision.
“I’d see circles or spots in my eyes, or I’d be sensitive to bright light, but I didn’t think too much of it,” he said. “I mentioned it to my doctor when I went in for a knee injury, and I quickly went from my primary care doctor to an optometrist who told me I had ocular cancer.”
Lynch was formally diagnosed with uveal melanoma in October 2021 and was referred to UW Health | Carbone Cancer Center. In December 2021, Dr. Michael Altaweel, surgical ophthalmologist, UW Health, implanted a small radioactive plaque at the tumor site to treat it.
“Paul had an excellent response and even retained his 20/20 vision, which is very uncommon,” said Altaweel, who is also a professor of ophthalmology and vision sciences at the University of Wisconsin School of Medicine and Public Health.
A tissue biopsy was also taken to see if it was the type of uveal melanoma that was slow growing or more aggressive; Lynch had the aggressive subtype.
Uveal melanoma is both a very rare cancer, diagnosed in only 2,000 to 3,000 patients per year in the United States, and the most common form of eye cancer, which often develops in the middle layer of the eye called the uveal tract, according to Dr. Vincent Ma, medical oncologist, UW Carbone, and assistant professor of medicine, UW School of Medicine and Public Health.
Lynch was determined not to let the diagnosis interfere with what he loves to do. No longer working for an airline, he thought about his love for travel and how he wanted to spend his time.
“I grew up in a family of ten kids, so the only way we were going on vacation was with a big camper,” he said. “I loved it then, and got one to travel with my own kids, and knew now more than ever I wanted to spend my time traveling like that again.”
Lynch sold his condo in Madison and bought a new motorhome in December 2023.
Six months after that, just two years and eight months after Lynch’s eye cancer had been eliminated, a routine test in June 2024 revealed the cancer had spread to his liver.
“For aggressive subtypes of uveal melanoma, there is a high chance it can return and spread to other organs,” Ma said. “When that happens, it almost always spreads to the liver.”
Effective treatment options for this type of metastatic cancer are limited, according to Ma.
“There is one treatment for Stage 4 uveal melanoma for patients with a specific immune genotype, but Paul did not have that,” he said. “The alternative option is immunotherapy with nivolumab and ipilimumab, but we haven’t seen a lot of success with that treatment.”
Luckily, there was another option, a therapy in which an interventional radiologist delivers a chemotherapy drug, melphalan, directly into the hepatic artery in the liver of patients whose uveal melanoma has only spread to their liver.
This therapy, called Hepzato, allows for a highly concentrated amount of the chemotherapy drug melphalan to completely treat the entire affected organ, the liver. This local therapy limits chemotherapy from traveling throughout the body, as it does with traditional systemic chemotherapy, therefore limiting toxicity exposure to healthy tissues and organs, which can sometimes cause more side effects like nausea and hair loss. Studies show 30-40% of patients have a response rate in the liver from this therapy, according to Ma.
Lynch completed all six rounds of melphalan by December 2024.
“I was very happy to see Paul experience disease control with minimal side effects,” Ma said. “After he completed the treatment, he had no evidence of active disease in his liver.”
Hepzato is a very new treatment option for patients like Lynch, having only been approved by the Food and Drug Administration in August 2023, less than a year before Lynch needed it.
“I don’t know if I’d be in the place I am today without this,” Lynch said. “I’m grateful not just that it exists, but that I lived near a great cancer center that could offer it to me.”
Carbone is one of the leading cancer centers for this therapy, according to Ma. It was one of the first dozen centers to offer it to patients when it was FDA approved and is the only cancer center in Wisconsin to provide it.
There are only a few known risk factors for uveal melanoma, including lighter skin and eye colors, similar to skin melanoma, but specific genetic mutations can also raise a person’s risk, which was the case for Lynch.
“When I took the genetic test to learn if I was predisposed to this or other types of cancer, I saw I had the elevated risk of ocular melanoma,” he said. “I wish I’d known that all my life, but I am glad I know now.”
He has since encouraged his siblings and children to get tested as well, in case they also have the gene and could benefit from more regular eye exams.
Lynch has been enjoying his summer in the motorhome, recently celebrated his 60th birthday with his family and friends, and hopes to travel to Utah in the coming months with his motorhome to visit friends.
“Time to put some miles on the big rig and spend more time doing what I love,” he said.
