Dr. Ryan Weight, DO, Oncologist
Interview by WSCR-NCORP Staff Member, Laura Gabbay
What role as an oncologist do you play in any given cancer, specifically melanoma and other skin cancers, research clinical trial?
As a medical oncologist providing care to patients with advanced cancer such as melanoma and other skin cancers, my role is best described as a director or navigator, one who provides guidance to patients based on knowledge and accumulated experience. For instance, medical oncologists are often the providers that identify clinical trial opportunities and present these options to patients who need treatment beyond the standard of care. If the patient elects to enroll on a clinical trial it is then our responsibility to oversee the patient’s care while on trial. For example, we will evaluate patients while on study including monitoring and reporting side effects in addition to determining if the clinical trial is working for the patient in the way that we hope it will. As oncologists, we decide with the patient when it is time to discontinue the clinical trial if the treatment is not working or there is an untoward side effect. We ensure that the best possible care is provided to the patient while maintaining the integrity of the clinical trial.
Tell us more about your research at UC Health Cancer Care and future research planned with Mountain Blue and within your own practice, and what reasons played a role in your choice to become an oncologist?
Two answers here:
Research. My research at the University of Colorado and Thomas Jefferson University before that focused largely on the understanding and management of immune-related adverse events related to immune checkpoint blockade drugs, which we use commonly for the treatment of many malignancies including that of melanoma and skin cancer. Clinical trial involvement has always been a pillar of my practice. I have enrolled and overseen many melanoma and skin cancer patients on clinical trials. I have served as a primary investigator for several practices changing clinical trials in melanoma in addition to authoring clinical trials. I have always enjoyed scientific writing and clinical trial design and implementation. I have also conducted benchtop and translational work in the study of circulating melanoma cells and melanoma related to DNA.
The Melanoma and Skin Cancer Institute (MSCI) is collaborating with Western States Cancer Research NCORP (WSCR-NCORP) Mountain Blue Cancer Care and Sarah Cannon Research Institute to provide a robust suite of clinical trial options to patients. The MSCI is heavily focused on clinical trial development and implementation in melanoma and skin cancers to offer cutting edge therapies to patients. Through the MSCI, I will continue my work in immune-related adverse event management through collaboration with local and national investigators who share an interest in better understanding immunotherapy-related toxicity.
Choosing Oncology. I chose to practice in oncology for several reasons. My first exposure to oncology came when I was pursuing a graduate degree in biomedical engineering at the University of Missouri. By happenstance I fell into a research project developing a method to detect circulating melanoma cells in the bloodstream, exploiting the melanoma cell’s inherent pigmentation. I was given the opportunity to work with amazing individuals during this period including my research mentor, Dr. Viator, and my clinical mentor, Dr. Dale, a surgical oncologist, both of whom inspired me to seek out a career in oncology. I knew long before medical school that I was going to be an oncologist. This experience coupled with the loss of my grandmother to pancreatic cancer around the same time served as the catalysts for my medical career and dedication to oncology, more specifically melanoma.
What specifically about Western States Cancer Research NCORP compels you to collaborate with our organization for the site management of your studies?
WSCR-NCORP provides immediate access to practice changing clinical trials. Their network allows for patients to enroll in trials at their primary medical oncology office with oversight by their primary oncologist, as opposed to an off-site location with a provider that the patient is not familiar with. The clinical research staff who oversee the trials will visit the office location where the patient is being cared for minimizing the need for patients to travel and improving access. This is a tremendous resource. WSCR-NCORP provides access to cooperative group trials and have also been supportive of sponsored clinical trials that fit our patient’s needs or profile.
What about cancer research, from your perspective as a physician, might our readers not know that you’d like to share?
People often underestimate the amount of time that it takes to properly oversee clinical trial operations and patients who are on trial. The time goes well beyond that of the time required to implement standard of care treatments. We, as physicians, dedicate this time to provide the best care for the patient.
Some patients feel as though a clinical trial is simply using them as a test subject, but this could not be further from the truth. I always explain to patients that we all learn from participation in clinical trials; clinical trial participation helps all cancer patients, providing additional options to manage their disease and a better understanding of the disease process and strategies on how to combat it. In addition, we spend extra time on clinical trials because we know that trials help people, either through knowledge gained or accessing a potentially life-saving treatment. Lastly, as a physician, I find clinical trials intellectually invigorating. They inspire us to do better.
According to the US Department of Health and Human Services, fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and differ according to demographic and socioeconomic factors. To what degree do you feel the rate of trial participation by adult cancer patients can be affected and what advice would you have for WSCR-NCORP as it addresses these barriers in its physician and patient outreach?
Wow! That is a loaded question. There is a lot to digest here.
Access, Redundancy, and Provider Champions. Regarding access, clinical trials must be accessible to both patients and providers. The barriers to access, as your question highlighted, are diverse and complex but not beyond our comprehension. Working to break down these barriers is critical. Potential solutions include reducing clinical trial start-up times, reducing paperwork, reducing institutional barriers, and clinical trial promotion. But most importantly, access relates to the physician-patient relationship and how the patient perceives the provider or perceives the institution and whether they have access to these resources.
Regarding redundancy, clinical trial enrollment often requires cross-sectional imaging to be repeated and biopsies to be performed for clinical correlates. While tissue is invaluable in understanding the pharmacodynamics of an intervention and imaging can improve standardization across a study, these procedures are often limiters to patient participation owing to the physical, financial, and emotional cost. In my opinion, this should be taken into consideration when composing a clinical trial.
Provider Champion. The providers must be a champion for the clinical trial. As mentioned, before it takes time to properly conduct a clinical trial and enroll patients. The provider must be invested in the success of the study and believe in the science supporting it.
What lies ahead for cancer research in 2021?
Short answer – A Lot. Immune checkpoint blockade, engineered cellular therapy, and signal transduction inhibition have revolutionized the way we approach cancer care. Advances in personalized medicine have allowed us to target tumors in ways that have not been accessible before. In the field of melanoma and skin cancer we are excited about the treatments on the horizon. Through the development and implementation of clinical trials such as those offered through WSCR-NCORP, we are gaining a better understanding of the complex mechanisms underlying immunotherapy and how the body’s innate immune system can be used to its maximum potential as an anti-cancer therapy. We are excited about the potential of adoptive t-cell therapies for melanoma, a treatment wherein the patient’s immune cells are captured from a tumor sample, multiplied in a lab, and given back to the patient as an active treatment against the melanoma. We now understand the importance of turning tumors that act like an immune desert into a lush immune cell filled environment, training the body’s innate immune system to act as an anti-cancer therapy. We are studying a myriad of pharmaceutical and biologic agents that do just that. This work will continue in 2021 and beyond.
What advice would you have for other physicians interested in pursuing cancer research opportunities at the local level?
Cancer research is not an option but a necessity. The disease of cancer and its associated complexities require us as providers to continue to move the field forward through engagement in clinical trials and cancer research. This holds true at all levels; locally, regionally, nationally, and internationally.
Cancers constantly evolve, and so must our understanding of the disease. It is important that we remain ahead of the curve and continue to think about ways that we, patients, and providers, can stay one step ahead.
Biography of Dr. Ryan Weight:
Dr. Weight moved to the Denver area to establish a practice closer to his family. He believes that his patients are an extension of that family — and his first priority is creating meaningful relationships with anyone under his care. He takes pride in helping patients and their families to understand the disease process in order to make informed decisions that fit their personal goals.
Dr. Weight has a background in Biomedical Engineering having received his undergraduate and graduate degrees in this discipline. It was Biomedical Engineering that led Dr. Weight into the field of melanoma and skin cancer. During his graduate studies he developed and patented a novel mechanism for detecting circulating melanoma cells in the human bloodstream.
Dr. Weight’s medical degree was conferred by Kansas City University of Medicine and Biosciences. He received his post-graduate training in Philadelphia, PA completing residency at Drexel University and fellowship training in hematology and medical oncology at Thomas Jefferson University. Dr. Weight has served as a faculty member at Thomas Jefferson University and the University of Colorado. He is board certified in Internal Medicine, Hematology, and Medical Oncology. Dr. Weight presents nationally on the subject of melanoma and skin cancer and has been published in leading medical journals. Dr. Weight leads The Melanoma And Skin Cancer Institute.