The James Cancer-Free World Podcast

The James is a leader in an advanced surgical technique that delivers heated chemotherapy directly to the cancerous cells in patients with rare and advanced types of cancers in the abdomen. “The heat helps the effect of the chemotherapy when it comes into contact with the cancer cells,” said Dr. Pamela Lu, a surgical oncologist and the lead of the James Hyperthermic Intraperitoneal Chemotherapy (HIPEC) team. “And the heat alone can have a toxic effect in killing cancer cells.” The HIPEC surgery is used for patients with cancer in the abdomen and peritoneal lining of the abdomen. “The cancer can look like tiny white spots, it can be raised or flat” and it can be located in several different areas, Lu said. The first step of the HIPEC procedure is to explore the abdomen and peritoneal lining “and take a survey of how much cancer is there,” Lu said. A scoring system is used to determine how much cancer is in several different regions, “how much surgery a patient will need” and if the initial cytoreduction surgery can be effective to remove all visible tumors. “Once this is complete, we proceed with HIPEC, through a hot chemotherapy bath that enters the site through tubes and a special profusion machine that allows the chemo solution to circulate through the abdomen.” The HIPEC technique leads to better outcomes because the direct access to any remaining cancer cells after surgery allows Lu “to give higher doses of chemotherapy with reduced toxicity.”

Pelotonia is where memories are made. In this episode, co-hosted by David John, MD, we asked several members of the James team who participate in this annual bike ride that has raised more than $300 million for research here at the James to share their favorite Pelotonia memories. For Robert Baiocchi, MD, “one of the coolest memories is seeing one my patients who was still in the midst of treatment zip by me like I was standing still.” Baiocchi has ridden every year and his son has joined him in recent years. Pelotonia is also a family affair for Marisa Bittoni, PhD. She rides with her husband and their two daughters. “One of the best moments in my life, an emotional moment, was crossing the finish line on the 100-mile ride. It was an amazing to cross the finish line together with everyone cheering.” Deb Sundi, MD, said he’s inspired by the other riders, especially the cancer survivors who ride, as well as the volunteers and the thousands of people cheering the riders along the route and at the different finishes. “It gives me an incredible surge of emotion and energy, and I’m truly overwhelmed by the moment.” Laura Schoettmer has been a volunteer at the James and Pelotonia for several years and began riding after her cancer diagnosis and treatment at the James. “I finished treatment in August and rode later that August. And then, the second time I rode, my daughter organized a [surprise] party of several friends and family members at the finish line.” David Cohn, MD, the James chief operating officer and chief medical officer has ridden in every Pelotonia. “The way Pelotonia connects us with the community is remarkable,” he said. “And the money we raise allows us to do things other institutions can’t do and to be increasingly more competitive in pursuing federal funding.” Cohn added his wife and daughter are Pelotonia volunteers and he rides with his son.

A new clinical trial at the James is pioneering the use of telemedicine to create better treatment options for patients with a rare form of pancreatic cancer. “This is the first nationwide telemedicine therapeutic clinical trial for cancer,” said Sameek Roychowdhury, MD, PhD, a physician scientist and leader in creating innovative ways to look at, understand and treat cancer. “It’s a new way of thinking and providing access to clinical trials.” Roychowdhury and his team at the James identified the fibroblast growth factor receptor (FGFR) gene and how “using a smart drug we could turn it off and slow the cancer growth” it caused. A traditional clinical trial using the smart drug showed promising results in patients with pancreatic cancer and the FGFR gene. Because this was a rare type of cancer, a national clinical trial would be costly. “How do we give patients access to this?” Roychowdhury said. The answer came during the COVID pandemic and the increased use of telemedicine. “That allowed us to connect the dots and utilize telemedicine,” he said. After a lengthy regulatory and approval process that created a well-thought out and workable plan, the clinical trial began in May. Patients identified with pancreatic cancer and the FGFR gene will be able to remain at home and coordinate their treatment with their local oncologists and Roychowdhury and his team, who will work in tandem. “Instead of a clinical trial in 50 locations and a $20 million price tag, we’ve reduced the cost to $2 million,” he said. Roychowdhury believes this clinical trial will lead to others for rare cancers and make it more cost effective for pharmaceutical companies to create smart drugs for rare forms of cancer. He is working to create a national alliance of oncologists to share ideas, best practices and create more telemedicine clinical trials for rare types of cancers that would otherwise never be opened. “We have identified seven more targets and clinical trials [here at the James],” Roychowdhury said.

The James Sarcoma Program continues to grow, with the recent opening of the multidisciplinary Sarcoma Clinic, new and cutting-edge clinical trials and a project in Ecuador to train doctors to treat sarcoma patients. “The entire continuum of cancer care is improving and that’s why it’s important to have a multi-disciplinary team and clinic, so patients have access to all these advances,” said Joel Mayerson, MD, director of the James Sarcoma Program. Mayerson described the recent advances made by the Sarcoma Program. A renowned sarcoma surgeon, in recent years Mayerson has been utilizing 3D printing to create replacement “bones” for sarcoma patients. “We can take scans and create [with the 3D printer] ‘bones’ the exact size of what we remove.” In a new clinical trial “we’ve found that if we give immunotherapy concurrently with radiation therapy it helps the radiation works better,” Mayerson said, adding “we have the first proton radiation center in Ohio and that allows us to hone the beam to a smaller area and damages less tissue.” Mayerson and the sarcoma team have been collaborating with the world-class veterinarians at Ohio State Veterinary Medical Center to create a probe that allows surgeons to see, in real time during surgery, the difference between normal tissue and tumorous tissue. Seeing the difference enables surgeons to remove less normal tissue, which leads to better function and quality of life for patients. “We used pilot data funded by Steps for Sarcoma to apply for and receive an Ohio State President’s Accelerator grant,” Mayerson said. Steps for Sarcoma is the annual fundraising walk; the next Steps will be held September 21. After operating on a patient from Ecuador, Mayerson and the sarcoma team “were asked to help build the program there,” he said. An Ecuadorian surgeon spent a year at the James working with Mayerson and his team, additional physicians will be trained and “our sarcoma tumor board helps guide them in treating their sarcoma patients … This has been one of the most satisfying things I’ve done in my career, to know that we’re impacting patients a couple thousand miles away.”

“Wouldn’t it be cool if …” is an expression the team at Pelotonia say on a regular basis. And, over the years, many of these “what if” ideas have become new programs and events and ways to engage and involve more people. “We’ve been cognizant and thoughtful about listening to our community,” said Joe Apgar, CEO of Pelotonia. “We get an amazing amount of feedback from people and that leads to improvements and new things we can do.” In this episode, Apgar talked about all the new things Pelotonia has added in the past few years, including the Challenger platform, kids rides, a gravel ride (October 4 this year) in Hocking Hills that includes a camping option and, for the first time this year, a run/hike/walk. The gravel ride came from a suggestion from Eric Tippett, who has ridden every year and is a member of the JPMorgan Chase team. The idea to add the run/hike/walk was “something we heard from a lot of people,” Apgar said. “They said I don’t ride a bike but if Pelotonia would ever do a run or a walk; I’m in.” The run/hike/walk loop through the woods is at the same location as the gravel ride. “We penciled in 75 people for it, and we already have more than 200 people signed up,” Apgar said. Apgar also talked about the growing number of kids events Pelotonia teams have created with support from the Pelotonia staff. “We think this will be a huge program over time,” Apgar said. The opening ceremony will feature O.A.R., a popular rock band whose members include a few Buckeyes. “I think this will be the most fun opening ceremony we’re ever had,” Apgar said.

The James Cancer Diagnostic Center has quickly become a valuable resource for the Central Ohio community and beyond. “Since we opened [in June 2020] we’ve had about 7,000 total visits … and about 40 percent have been diagnosed with some type of cancer,” said Tina Sowers, the Center’s administrator. In this episode we are joined by Raquel Reinbolt, MD, medical director of the Center, Sowers, and Rupa Ghosh-Berkebile and Victoria Krogg, the Center’s two advanced practice providers. The Center opened in the midst of the COVID epidemic. “The goal was to reach more patients and open a new front door to the James,” said Reinbolt, MD. She added people without a primary care physician can “self-refer to us and we can accommodate telemedicine visits. This leads to earlier diagnoses and better outcomes and quality of life. That’s why we’re such strong advocates for screenings and for not ignoring symptoms.” The Center is located on the 5th floor of the James Cancer Hospital on The Ohio State University campus. Suspecting you might have cancer, and then an actual diagnosis, can lead to heightened levels of anxiety. Ghosh-Berkebile and Krogg excel at helping patients understand their cancer diagnosis and to reduce some of their fears. “We help the patients understand what’s happening to them and that we care about them,” Ghosh-Berkebile said.Krogg uses a whiteboard to describe complicated cancer and medical procedures. “It really helps, especially for patients who aren’t familiar with medical terms, which is most patients. This job is rewarding because we help patients during a vulnerable time in their lives.” “And we let them know there is hope and we will get you to the right people at the James,” Ghosh-Berkebile added. The James Cancer Diagnostic Center is one of the first in the country, and other major cancer centers have taken notice. “Several of these cancer centers have reached out to us,” Sowers said. “They want to know how we’re doing it and they want to learn from us.”

There has been a lot of news and some confusion in recent months about the connection between alcohol consumption and cancer risk. In this episode, Dionisia Quiroga, DO, PhD, a James breast cancer specialist, explains the recent findings of the U.S. Surgeon General, what they mean and what people need to know to reduce their cancer risk. “One of the data findings was that most Americans don’t know alcohol is a risk factor for cancer development,” Dr. Quiroga said. “It’s important people know so they are empowered to make the right decisions for themselves.” Previous research indicated one alcoholic drink per day for women and two for men was a safe level of consumption. “When we look at the new data, it shows that any alcohol consumption can increase the risk,” Dr. Quiroga said. One of the theories about why alcohol consumption increases the cancer risk is that “alcohol in the system breaks down into substances that can cause DNA damage” that leads to cancer. “And alcohol can alter the hormones in the body and most cases of breast cancer are linked to some sort of hormone issue,” Dr. Quiroga said, adding this could also be a factor in prostate cancer risk. “Alcohol use is also tied to other types of cancer where alcohol passes through the body and is processed, such as head and neck cancer, colon cancer, and liver cancer since the liver breaks down alcohol.”

“Ten years ago, there were relatively few treatment options [for bladder cancer] compared to what we have today which is a relative wealth of options,” said Debasish Sundi, MD, a James urologist and bladder cancer specialist. In this episode, Dr. Sundi explained the function of the bladder (storing urine), the different types of bladder cancer (contained within the bladder and metastatic), how new immunotherapies have led to better options and outcomes, and his research which focuses on identifying the biomarkers in a patient’s bladder cancer by analyzing their urine, instead of a more invasive procedure using a scope. There are about 80,000 new cases of bladder cancer diagnosed ever year in the United States and “about 75 to 80 percent are in males,” Dr. Sundi said, adding “the number one cause is exposure to tobacco smoke and tobacco products.” The primary symptom is blood in the urine. “If you see blood in your urine, even if it’s just pink, it is worthwhile to talk to your primary care doctor or see a urologist.” Clinical trials have led to the development and approval of several new immunotherapy treatments. “The challenge is we do not have any good biomarkers to tell us how our patients will respond,” Dr. Sundi said. “My lab is developing an assay [test] to non-invasively make an assessment. We’ve learned that if we look at the immune cells in the urine of someone with bladder cancer, they are similar to the immune cells in their tumor … And this could lead to significantly improving the therapeutic options and helping doctors pick the best medicine for their patients from the start.” Dr. Sundi said his research is motivated by his patients. “When I started in this field the experiences of patients with bladder cancer was something we could and should improve,” he said. “Working toward this is the fuel that is self-sustaining and there is so much excitement in terms of the innovation happening in the bladder-cancer field.”

Cancer impacts the entire family of a patient, including the children. To help parents help their children through these difficult time periods, the James has created a team of certified child life specialists (CCLS). “We help parents navigate these situations and conversations,” said Sami Rundo, CCLS. The help comes in many forms, Rundo explained. “It starts with understanding the medical situation [of the patient] … And then we prepare the family to navigate discussions and conversations. What does that conversation look like? And do they want our child life services to have these discussions with their children or provide the resources they can use in these conversations.” Rundo explained how these discussions can trigger emotions and that parents can “embrace the fact there will probably be some tears and the need for breaks and walks.” She also detailed why it can be important to explain the medical procedures that will take place, such as surgery and radiation treatments, and how their parent’s treatment could impact a child’s daily routine. The team has a doll they utilize to visually show children different medical procedures and what a port that delivers chemotherapy looks like. “We also talk about the ways in which the children can be helpers, caregivers,” Rundo said. “And what’s appropriate for that child. Can I get you a blanket if you’re cold, but maybe not taking care of their other siblings.” The James certified child life specialists can let parents know about cancer-themed children’s book they might want to utilize in their discussion with their children, and “we can create customized books for a family,” Rundo said. The James certified child life services team is relatively new and growing. “Over time [with a family] we develop trust and an openness of communications,” Rundo said. “I’ve learned so much about families and to see them grow and become stronger during these difficult times is really profound.”

Because there are no symptoms in the early stages of pancreatic cancer “about 75 to 80 percent of patients are diagnosed in the later stages of the disease,” said Somashekar Krishna, MD, a James physician scientist who specializes in the early detection and screening of pancreatic cancer. Krishna and the team of pancreatic cancer experts at the James are using enhanced screening and artificial intelligence (AI) to better identify pre-cancerous cysts and cancerous tumors in the pancreas; and are the first in the world to use high-tech ablation techniques to attack and kill pancreatic cysts and tumors in a new clinical trial. Most pancreatic cancer tumors begin as pre-cancerous cysts and are most commonly found in people 60 and older. “For people in their 50s there is about a 10-percent prevalence, this doubles in people 60 to 70 to 20 percent and is 25 to 30 percent in people 70 to 80,” Krishna said, adding, “most are small and never grow and become cancerous.” Endoscopy procedures are used to better “see” these cysts and cancerous tumors, and the use of artificial intelligence is another tool to identify and determine the risk factor of pre-cancerous cysts. “The tip of the endoscopy probe can see even the tiniest structures in a very detailed manner, and we can pass a needle through the scope and do a biopsy and establish the risk,” Krishna said. Surgery is one option, but the procedure is quite invasive and not easily tolerated by older patient with other medical issues. “A new option is ablation, using heat, in a very precise and careful manner,” Krishna said. “We are the only ones doing this in the United States and have done this with nearly 30 patients in a clinical trial.” Krishna is determined to improve screening and treatment for pancreatic cancer and reduce the mortality rate. “Early in my career, 80 percent of patients diagnosed with pancreatic cancer did not make it more than a year,” he said. “We want to change these outcomes to intervene early and with better and better treatment options.”

“Primary care physicians are your first line of defense against cancer,” said Matthew Farrell, M.D., an Ohio State Wexner Medical Center primary care physician and a clinical associate professor of family and community medicine. Prevention, screenings and early detection are crucial and begins with a patient’s family history with cancer and other medical issues. “We are thorough and ask about their first-degree relatives, their parents, siblings and children, and their secondary relatives, such as grandparents and aunts and uncles,” Farrell said. “If I see a pattern, a certain number of relatives with the same cancer, especially at an early age, there could be a genetic factor.” A patient with an inherited genetic mutation will then be screened at an earlier age and more often. Dr. Farrell also talked about the importance of children receiving the Human Papillomavirus (HPV) vaccine that prevents certain types of cancer. He examines patients to detect skin cancer and melanoma in the early stages. “Skin cancer is the most common form of cancer and it’s personal for me; my mother was diagnosed with melanoma three times … and she’s doing fine.” Breast cancer and prostate cancer are two of the most common forms of cancer. Dr. Farrell discussed when women should begin getting yearly mammograms, and why and when men should begin to undergo regular Prostate-Specific Antigen (PSA) tests. Men and women without a family history of colorectal cancer should get their first colonoscopy at 45. “My brother-in-law was 52 when he had his first colonoscopy,” Dr. Farrell said. “They found a large tumor in his colon; it was removed, and he’s been cancer free for 20 years now.” Lung cancer screenings are relatively new and recommended for long-time smokers. They are vital because “if you wait until there are symptoms it’s very hard to treat and cure,” Dr. Farrell said, adding “I’m fortunate to be part of the Ohio State system and the James where we have experts and specialists for every type of cancer and medical issue my patients have.”

Colorectal cancer can affect anyone, but healthy choices and timely testing can help reduce risk. Ohio State gastroenterologist Peter Stanich, MD, explains how lifestyle choices like diet and exercise, combined with screening and genetic testing, can help everyone reduce their risk of colorectal cancer. Learn more about colon cancer, including risks, symptoms and treatment: cancer.osu.edu/coloncancer Watch The James Cancer-Free World Podcast on YouTube: go.osu.edu/CancerFreeWorldPodcastWatch

The reach of the James Cancer Hospital extends far beyond Central Ohio. As part of Ohio State’s Global One Health Initiative (GOHi), Robert Baiocchi, MD, PhD, is leading the research, vaccination and treatment efforts in Ethiopia for patients with lymphoma. “Lymphoma, a cancer of the white blood cells, is far more common in Sub-Saharan Africa, and afflicts people at a younger age” said Baiocchi, a James medical oncologist who specializes in treating patients with blood cancers. The prevalence of malaria and the Epstein-Barr virus (EBV) has led to the increased number of lymphoma diagnoses. “Starting in 2015 we opened a lab in Addis Ababa [the capital of Ethiopia] to study these viruses and how they cause cancers,” Baiocchi said, adding the initial research was to determine why the lymphoma rate was so high. “We’re zeroing in on a couple of interesting findings; children who get malaria and EBV, that seems to be the perfect storm [for lymphoma].” Differences in the genetic makeup of people in Sub-Sharan Africa could be another factor in the increased lymphoma rates. Baiocchi and his team, and their partners in Ethiopia, are working on vaccines for malaria and EBV. “Studies tell us the virus here [in the United States] is different from the viruses in Ethipia and the vaccines we use here won’t work there,” he said. “It’s important to understand the genetic makeup of EBV in order to develop a vaccine that will be effective in that region.” The standard of care at the James for lymphoma patients includes a combination of chemotherapy drugs – and has proven to be very effective. “The resources for this aren’t available in Ethiopia,” Baiocchi said, adding the James is developing a less-expensive, targeted therapy that shows promise. There are also plans to create a facility in Addis Ababa where lymphoma patients will be treated with cell therapy.

David Cohn, MD, described one of his goals for patients of the James. “When a patient and a family say we didn’t want to be diagnosed with cancer and we didn’t want to be at the James Cancer Hospital, but after this experience there’s nowhere else we’d rather be and that is the end result of empathetic care and compassion in the delivery of that care,” said Cohn, the interim chief executive officer and the medical director of the James. In this episode, Cohn and John Schaffner, MBA, the director of coaching at Ohio State’s Fisher College of Business, described a new coaching program for James physicians that’s part of the Physician Wellness Program. This coaching focuses on compassion and helps physicians better understand their careers and goals and utilize compassion when working with their colleagues and patients. “It’s not that our physicians had problems, they’re exceptional, it was rather, how can we support our people so they can flourish,” Cohn said, adding this type of leadership initiative was welcomed by his team. Schaffner, who leads the James coaching program, explained his definition of empathy. “There’s cognitive empathy, that’s noticing someone else’s emotions; there’s empathetic concern, which is an emotional reaction to someone else; and this empathy plus action equals compassion.” There are currently 15 certified coaches who work with the 240 attending physicians of the James. “I love working with physicians,” Schattner said. “They’re smart and ambitious, understand the idea of flourishing and they do the work.” Some of these physicians, he added, are new to leadership positions and coaching can help them communicate better and build comradery. The coaching program is new and funded through a philanthropic donation to the James. Cohn said the program is designed to help each physician be the best version of themselves they can be with the overreaching goal of delivering the best-possible care to James patients. “Everything we do is driven by the delivery of care to our patients and this is another process to help us get there,” he said.

“We’re so fortunate to have so many individuals come to us and want to share their time and help our patients and families,” said Kathleen Kiene of the 300 James Cancer Hospital volunteers. Kiene is the Administrative Associate Director of System-Wide Volunteer Services, and she recruits, trains and mentors her small army of volunteers, who include a large number of former James patients … such as Laura Schoettmer. “I just want to make people feel hopeful, because there is so much hope here,” said Schoettmer, who was diagnosed with lymphoma several years ago and is now in remission. Kiene described all the different ways in which volunteers contribute to patient care, which includes: wayfinding and escorting, interacting and helping patients while they receive chemotherapy, in the surgical visitor’s lounge, as waiting room ambassadors, in the James’s outpatient facilities. “In our Restful Nights program volunteers are there from 5:15 to 7:15 p.m. and they man carts and visit patients and offer amenities,” Kiene explained. “Conversations start and there are bonding moments between the patients and our volunteers. One volunteer watched Jeopardy with a patient and another patient played the guitar and our volunteers were there to listen and be part of that.” Schoettmer began volunteering in 2015, three years before she was diagnosed with cancer. She lost a cousin to breast cancer “and I was very angry and wanted to do something.” Some volunteers may initially be concerned interacting with cancer patients can be difficult emotionally. “It’s so fulfilling and so rewarding and every Thursday morning when I walk into the James [to volunteer] I feel exhilarated,” said Schoettmer, who volunteers in the chemotherapy clinic. For more information of becoming a James volunteer: https://cancer.osu.edu/for-donors-and-volunteers/volunteering/volunteer-opportunities

The James Cancer Hospital is a leader is helping cancer patients deal with the pain that can be associated with treatment. “Our inpatient oncology rehabilitation service is the first in Ohio, the second in the United States and the third in the world to be accredited,” said Whitney Luke, MD, medical director of oncology rehabilitation at Ohio State. “We now have an inpatient and an outpatient oncology rehabilitation program, and I could not have developed these programs if I wasn’t at a comprehensive cancer center like this,” added Luke, who led the creation of these programs and is a pioneer in the field of pain management for cancer patients. “I’m so fortunate to be at a hospital where I could grow these programs and where we have so many experts in so many different fields.” Luke described how some cancer treatments can lead to varying levels of pain for patients, and why it is important to work with each patient to develop a plan to reduce their pain. “Our team includes oncologists and physicians, physical, occupational and speech therapists, social workers, psychologist; the goal is to improve functional outcomes for patients so they will better tolerate treatments and get them home doing the things they normally do.” Some of the many medical options for treating pain include: injecting joints with a combination of steroids and anesthesia; implanting a device in the spine that provides electrical stimulation at regular intervals; an internal pain pump that releases medication directly to the points of pain; and the use of ablations (heat) to clock nerves. “When I have a patient who was in severe pain come back and tell me they were able to go to their daughter’s wedding and feel normal, that opportunity to help patients during their cancer journey, that’s what motivates me,” Luke said.

Scientists have known for many years that smoking tobacco products greatly enhances the lung cancer risk and is the number-one cause of this deadly disease But what about vaping and electronic cigarettes? “Vaping is so new, and it takes years and years for lung cancer to develop so we don’t yet know the effects,” said Marisa Bittoni, PhD, MS, BS, an Ohio State scientist whose research focuses on how lifestyle choices such as diet, exercise and smoking/vaping can impact and increase the risk of lung cancer. Bittoni and her colleagues at the James are pioneers in researching the cancer-related effects of e-cigarettes. She led a new study that has shown the combination of smoking and vaping greatly increases the lung cancer risk. The study looked at Ohio State patients already diagnosed with lung cancer and a control group of people who had not been diagnosed with this disease.“Compared to non-smokers, smokers have about a 10 times higher risk of lung cancer,” Bittoni said. “And people who smoke and vape have about a 40 times higher risk than non-smokers.” Bittoni said that further, follow-up research is needed to confirm these initial findings and find out even more. “We’re at the start of a new wave of research [on the effects of vaping],” she said. “The tobacco industry wants to promote vaping as a safer alternative to smoking, but we don’t really know if that’s true yet.” This new research is another step forward for Bittoni. “My whole career has been looking at risk factors and survival,” she said. “By improving your diet and exercising and not smoking you can reduce your cancer risk, and, even after diagnosis and treatment improvements in diet and exercise can help people live longer. There are estimates that 30- to 40percent of all cancers could be avoided by better lifestyle choices.”

The OSUCCC -James is a leader in the treatment of pancreatic cancer, with the utilization of robotic Whipple surgery, the use of chemotherapy and radiation before surgery, multiple clinical trials designed to find even better ways to treat patients and a large multidisciplinary pancreatic cancer clinic.“We’re always thinking about what’s the next step and about the patient of tomorrow, that’s a huge driver,” said Susan Tsai, MD, MHS, a surgical oncologist who specializes in pancreatic cancer and is Director of the OSUCCC – James Division of Surgical Oncology. “The pancreas helps regulate blood sugars and also helps you digest food,” Tsai explained, adding that it’s hard to diagnose, which means patients often come to her with later-stage cancer. “In 70 to 80 percent of the patients we see, they will have recurrent disease somewhere else in their body,” Tsai said, adding this statistic has led to a new way to treat patients. “In the old days we’d often rush patients to surgery to remove the cancer as quickly as possible, but because the recurrence rates were so high maybe that isn’t the best way to treat patients. Now, we utilize systematic therapy [chemotherapy and radiation] upfront, before surgery and we’re seeing better results.” The development of robotic Whipple surgery to perform the complex and invasive pancreatic cancer surgery is another innovation. Using previous surgical techniques “there was about a 30 percent mortality rate,” Tsai said, adding the advances of the less-invasive and more precise Whipple surgery “practiced at a high-volume comprehensive cancer center such as the James have reduced that to less than 3 percent.” To date, pancreatic cancer has not been a good target for immunotherapy. “Now, we have been able to target a genetic mutation, called KRAS, a gene that drives many different types of cancer,” Tsai said, adding clinical trial are now testing drugs that appear to be able to target KRAS and enable the immune system to recognize and attack them. In another, soon-to-open clinical trial in which Tsai helps lead, the molecular profile of a biopsy of a patient’s pancreatic cancer is analyzed to determine which chemotherapy drug to utilize. “This could be a great resource for patients,” Tsai said.

Prostate cancer is the second most common cancer in men, behind only skin cancer. In recent years, advances in screening, surgery and radiation treatment have improved outcomes and led to an increase in what is known as active surveillance after the initial diagnosis of prostate cancer. “The goal of active surveillance is to maximize the quality of life for patients while at the same time preserving the quantity of life,” said Akshay Sood, MD, a James urologic oncologist who specializes in treating prostate and bladder cancer. Dr. Sood explained the importance of screening, the prostate-specific antigen (PSA) test and what it means, the Gleason score and how these numbers help oncologists determine when to treat patients. He also discussed what’s involved in prostate-cancer surgery and radiation treatments, and advances in both of these areas. Dr. Sood is also one of the leaders of the James Multidisciplinary Prostate Cancer Clinic and he described the benefits to patients of this all-in-one clinic that includes a large team of prostate cancer experts. “Unfortunately, there are no symptoms, which is why screening is so important,” Dr. Sood said of prostate cancer. PSA screening should begin at the age of 45 for most men. African American men (who have a higher rate of prostate cancer) and those with a family history of prostate and other types of cancers should begin their yearly PSA screenings at 40. “A PSA level below 4 is considered normal, while a score above 4 is abnormal,” Dr. Sood said. A high score will often lead to a biopsy to determine of the patient has cancer and, if they do, where it ranks on the Gleason scale and the genetic mutation causing the cancer.

Liquid biopsies and circulating tumor DNA are changing and improving the way cancer is detected and treated. In this episode, Sameek Roychowdhury, PhD, MD, explains the basics of circulating tumor DNA, how it’s being used at the James, his lab’s clinical trials, and the promising future. “When a normal cell and a cancer die they sheds fragments of their DNA,” he said. “Cancer can be detected in the blood by looking for these fragments and this is becoming an important research tool and treatment tool for the care of cancer patients.” For example, about 50 percent of cancer patients who have a tumor surgically removed will have a recurrence. And it’s very difficult to determine which patients will have the recurrence. Minimally invasive liquid biopsies after surgery “helps us stratify and determine patients with a lesser recurrence risk who won’t need chemotherapy or immunotherapy treatment versus those patients who need even more treatment than we’ve normally given them in the past.” Monitoring circulating tumor DNA “also becomes part of the surveillance program and we’ll do a precise test every three months that measures fragments in the blood,” Roychowdhury said, adding that finding a recurrence of cancer from these fragments, months before it would appear on more traditional scans “allows us to make a diagnosis about the molecular drivers of the cancer and we can begin treatment earlier and better understand which treatment options will work best.”