Federico de Armas Heinzen: Managing Metastatic Melanoma Despite an Interruption in Treatment Because of COVID-19

In 2015, Federico de Armas Heinzen felt a swollen lymph node under his right arm and it concerned him. Federico was initially diagnosed with melanoma in 2005 and, for a decade, had no signs of the cancer recurring.

So, Federico—a Uruguayan living in Mexico City, Mexico, with his wife and young daughter—contacted Antoni Ribas, MD, PhD, FAACR, a physician-scientist specializing in melanoma and immuno-oncology at the University of California, Los Angeles (UCLA), California.

“When Federico contacted me, he had developed metastatic melanoma that had spread to his eye, bones, adrenal gland, and multiple lymph nodes,” Dr. Ribas said. “He and his wife wrote to me that they didn’t have any treatment options in Mexico and asked if we have any ongoing clinical trial or treatment option,” Dr. Ribas recalled.

At the time, UCLA was part of a phase I clinical trial to test the efficacy of two molecularly targeted therapeutics against BRAF and MEK—two proteins that drive the growth of several types of cancer—combined with immunotherapy to treat patients with melanoma, an idea that had come from years of research.

Federico qualified and was able to participate in that trial.

“I knew that the distance was a problem, but I also knew that this was the best possible option he may have,” Dr. Ribas remembered.

Although the molecularly targeted inhibitors could be taken orally, the immunotherapeutic had to be administered by infusion. So, for Federico, participating in the clinical trial required trips from Mexico City to UCLA every two weeks. In addition, the clinical trial required routine blood tests and scans to monitor his response to the treatment. Federico started to respond to the treatment.

“When I started the treatment in January 2016, the cancer had spread in my body. By the end of July, I was clean,” recalled Federico, as his nurse prepared him to receive his immunotherapeutic by infusion.

“I have 30 minutes to get the medicine to my blood, and it’s magical, you know, because it works,” Federico chuckled.

In March 2020, when the pandemic hit and the United States implemented strict travel restrictions to minimize the spread of COVID-19, Federico was unable to come to Los Angeles for his biweekly treatments.

Not only was Federico unable to come to UCLA for infusions of the immunotherapeutic, but he also lost his access to the molecularly targeted therapeutics, oral medications that were provided to him during his visits to UCLA.

“For five months, he was not able to come and continue on the clinical trial. That’s troublesome because we knew the treatment was keeping his melanoma under control,” Dr. Ribas said.

“COVID-19 really affected him and really affected all of us because we knew it was hard to deliver the care to him with all of these disruptions,” he added. “After things started to improve, we went from doing it all in person to doing video visits and were able to ship drugs to him, which was not allowed before the pandemic. That’s one of the things that I hope will be carried on after the pandemic when we go back to normal business.”

Despite the new ability to mail the molecularly targeted therapeutics to him in Mexico, Federico was still missing the infusions of the third medication in the trial, the immunotherapeutic that had to be administered by infusion at UCLA. Federico couldn’t come back to UCLA for in-person visits until October 2020.

“It was really nerve-racking for all of us. It was very hard to know that you have a patient to whom you can’t deliver the treatment that had been benefiting him,” recalled Dr. Ribas.

Unfortunately, while Federico was dealing with interruption in his cancer treatment, his scans showed he had developed a brain tumor that was independent of his melanoma. So, in the midst of a pandemic and an interrupted treatment for his melanoma, Federico had to undergo radiation therapy to treat his brain tumor.

“That was really tough. When you have these metastases in your body, it’s hard to face,” recalled Federico.

Federico’s health care team advised him to get vaccinated for COVID-19 as soon as possible, and he did so when he was able to travel to UCLA.

“You have other patients and these people that take care of us. I needed vaccination for that reason. And for me,” Federico said.

Although he feels it’s not the same as an in-person visit, Federico is also grateful that he was able to keep in touch with his health care team at UCLA via telemedicine.

“At least you have the support from them, you know, whatever it should be,” Federico added.