The James Cancer-Free World Podcast

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.

The James Center for Tobacco Research “is truly one of the largest, if not the largest centers in the country and we clearly have the greatest breadth and depth of tobacco research in the country,” said Ted Wagener, PhD, director of the Center. Since the adoption of the 2009 Tobacco Control Act, the U.S. Food and Drug Administration has regulated the tobacco industry. Wagener compared this to “whack-a-mole,” explaining that “the tobacco industry is always looking for loopholes.” These loopholes include the use of menthol, synthetic cooling agents, electronic cigarettes and flavored products for electronic cigarette use that are more attractive to teenagers. The tobacco industry is also developing a synthetic nicotine product that might not be considered a tobacco product in order to avoid regulation by the FDA. “We can, as researchers, affect legislation through our research … and we’re trying to stay one step ahead of the [tobacco-producing companies],” Wagener said. “And that’s tough to do because they’re the ones creating the products.” For example, Wagener explained, tobacco companies use menthol to make their products less harsh and more palatable. “Menthol has a cooling sensation that makes it easier for young people to inhale.” He adds that research has shown that the tobacco industry targets younger users through these types of “starter programs,” hoping to create lifelong users. Initial research indicates electronic cigarettes are a nicotine delivery system that “delivers less carcinogens and toxicants than cigarettes,” Wagener said. “But still there are some carcinogens and toxicants and so, it seems to me, the cigarette companies are trying to come up with ways to negate the bad effects and still deliver nicotine. So far they haven’t been able to. In the meantime, they’re going to sell whatever they can and try to get away with whatever they can.” For example, while flavors for electronic cigarettes are banned, they are still readily available. While the number of smokers in the United States is dropping “we still have 500,000 people a year dying of tobacco-related diseases,” Wagener said.

“I see myself as an educator first and foremost,” said Bridget Oppong, MD, an OSUCCC-James surgical oncologist who specializes in breast cancer surgery at the Stefanie Spielman Comprehensive Breast Center and is also the deputy director of the James Center for Cancer Health Equity. In this episode, Oppong shares her wealth of knowledge about the importance of self-examinations and breast cancer screenings; advances in surgery, chemotherapy and immunotherapy; radiation; and outreach programs to underserved communities in Columbus and throughout Ohio. “Early detection is saving lives,” she said. “The five-year survival rate for early-stage breast cancer is over 90 percent … [and for women diagnosed with later-stage breast cancer that has metastasized] we can manage their breast cancer and they can still live a long life.” Self-examinations and annual mammogram screenings are the key to early detection. “I always advocate for self-examinations,” said Oppong, who described how often and what to look for during a self exam. “And if you notice anything different, bring it to medical attention immediately, to your primary-care physician or oncologist.” The recommended age for women to begin annual mammograms is 40. “But if you have a family history of breast cancers or any cancers at an early age, I recommend starting mammograms five to 10 years earlier,” Oppong said. “For example, if your sister was diagnosed with breast cancer at 35, I want you to get started at 30 at the latest.” The average age for diagnosis of breast cancer is about 60, but Oppong said more younger women are being diagnosed in recent years. She also explained the significance of the BRCA1 and BRCA2 (the breast cancer inherited mutations) and how having this mutation increases the breast-cancer risk and means starting mammograms earlier and adding MRIs for some patients. She also described how breast feeding can reduce a women’s risk of developing breast cancer. As for treatment, “we have seen awesome advances in all three modalities: surgery, medical (such as chemotherapy and immunotherapy) and radiation,” Oppong said. She described some of the advances in surgery, including the nipple-sparing surgery she performs and how she works with plastic surgeons. Oppong is passionate about and determined to reach out to underserved communities. “The advancements are real and are amazing and our focus is to make sure that all women and men have equitable access to all levels of cancer care from screenings all the way through to survivorship.”

“Cell division is fundamental to the growth of every living thing and when it goes wrong and is out of control this is the basis for all cancers and understanding this process is important,” explained Sir Paul Nurse. When it comes to understanding the fundamentals of cell division and the cancer connection, Sir Paul is a world-renowned expert and pioneer. He was awarded the Nobel Prize in Physiology or Medicine in 2001. In this podcast, he explained the ideas that sparked his ground-breaking research and how his findings gave scientists around the world the insight and tools they needed to develop advanced cancer therapeutics such as immunotherapy. Sir Paul is adept at explaining his work and the complexities of science in easy-to-understand language, combined with his keen intellect, modesty and a warm sense of humor. He’s someone you will enjoy spending time with. As a young scientist, Sir Paul said he knew there would be a lot of ups and downs, and he was determined “to study something important and what is more fundamental than the process that is the basis of all growth … I didn’t do this to cure cancer, but to understand the principles behind dividing cells and I thought by understanding this it would have implications for cancer and other diseases.”

Sir Paul, director and chief executive of the Francis Crick Institute in London, was recently in Columbus as the recipient of the 26th Annual Herbert and Maxime Block Memorial Lectureship Award for Distinguished Achievement in Cancer. In addition to delivering a lecture, the Block Lectureship includes a mentor/mentee collaboration between Sir Paul and Li-Chun Tu, PhD, an Ohio State and OSUCCC-James assistant professor in the Department of Biological Chemistry and Pharmacology. Dr. Tu joined the second half of this podcast, and described her work in genetics. Sir Paul and Dr. Tu look forward to working together. “I truly believe he will give me such good advice,” Dr. Tu said.

Skin cancer is the most common form of cancer, and melanomas are the most serious form of this disease. “And we project an increase every year of 20 to 30 percent more cases,” said Merve Hasanov, MD, a James skin cancer and melanoma expert whose research focuses on how melanomas metastasize and spread to the brain. In this episode, Hasanov describes how exposure to ultraviolet light from the sun is the leading cause of all the different types of skin cancer, and that family history is another indicator. “Sun exposure creates a cumulative risk over a lifetime and some people, with a fair complexion, are at higher risk,” she said. Precautions that reduce risk “are decreasing your exposure to the sun, using sun block and reapplying every 50 to 90 minutes and avoiding tanning beds, which use UV rays,” Hasanov said. “Wear a hat or long sleeves, and, even when it’s cloudy or during the winter the UV rays are coming from the sun.” Advances in treatment have led to better outcomes for patients, especially when melanomas are detected in the earlier stages, before they have metastasized and spread to other parts of the body. Because of this, “it’s now recommended that you should, once a year, get a thorough dermatological exam,” Hasanov said, and she also explained the A-B-C-D-E method of detecting skin cancer: asymmetry, border, color, diameter and evolving. Immunotherapy has been a big breakthrough for the treatment of melanomas. “Melanomas have a lot of molecular and genetic changes that can be recognized by the immune system,” she explained. “But cancer cells are smart and can shut down the immune system. But immune checkpoint inhibitors [in immunotherapy drugs] take the brakes off the immune system so the T cells better recognize and kill cancer cells.” Hasanov said that the melanomas in 10 to 12 percent of patients diagnosed in the early stages of their disease will eventually metastasize and travel to the brain. “My research focuses on detecting this earlier when we have better treatment options and survival rates,” she said. Hasanov and her lab have developed a scoring system to determine which early-stage melanoma patients are most likely to develop brain metastasizes. These patients can then be screened on a regular basis. “We’re hoping that this information will lead to better guidelines and trying to spread this information to more physicians and oncologists.”

The Pelotonia Institute of Immuno-Oncology (PIIO) continues to grow and develop novel new cancer treatments since it was created in 2019 with the help of a $104 million funding commitment from Pelotonia. “I think that historic moment showed the collective commitment of the [OSUCCC – James] and the entire community to make huge progress in the field of immune-oncology,” said Zihai Li, MD, PhD, founding director of the PIOO. In this episode, Li discussed the growth of the PIOO and three of the Institute’s biggest projects.

“We have recruited 32 amazing investigators from around the nation, and adding them to our existing faculty, we now have more than 100 members in the PIOO,” he said. “We have obtained $39 million in funding nationally, $22 million from the National Cancer Institute, published 1,200 scientific papers and conducted 230 immuno-oncology clinical trials and are recruiting patients now to test the next generation of immunotherapeutics [in clinical trials].” Li’s lab is conducting a groundbreaking clinical trial in which re-engineered T cells from a patient’s blood are genetically modified to better recognize, attack and kill cancer cells in glioblastomas, a form of brain tumor extremely difficult to treat. “We are making the leap from using cellular therapy for solid tumors,” Li said, adding this treatment, known as CAR T-cell therapy has been effective “in treating a variety of leukemias and multiple myeloma. Nothing has been approved for treating solid tumors and we think this is a potential way to do it … and we’re very excited by this.” The PIOO is also working on better understanding the genetic differences between men and women and how this impacts the immune system’s ability to fight cancer. “It turns out male hormones can actually suppress the immune system, the T-cell response, and, if you remove the suppressive switch will this make the T cells more effective,” Li said. A third major project of the PIOO is the development of the next generation of CAR T cell therapy. Instead of targeting one molecule on cancer cells “we’re re-engineering T cells to target three molecules,” Li said. “This has never been done by anyone else and after painstaking work, we’ve obtained approval from the FDA [for a clinical trial].” Li has ridden in Pelotonia since he was named founding director of the PIOO in 2019. “I didn’t feel like I was riding a bike,” he said of his 2024 ride. “I felt like I was doing something special, like we were all marching for a purpose and cause and a destination, which is to end cancer as we know it.”

Two James physicians are part of an international clinical trial that utilizes an artificial intelligence (AI) algo rhythm to better determine the risk factor of a patient’s colon cancer and whether or not chemotherapy is necessary after surgery. “The algo rhythm determines if a patient is high, medium or low risk category,” said Eric Miller, MD. Miller is a radiation oncologist who specializes in treating patients with gastro-intestinal cancers such as colon cancer. He has teamed with Vidya Arole, MD, MBBS, an assistant professor in the Department of pathology and an expert in the pathology of colon cancer. The clinical trial began after Arole met a team in Norway. “They had a tool, an algo rhythm, for stage 2 and 3 colon cancer patients and we decided to collaborate,” she explained. “They basically trained their algo rhythm from thousands of patients in Europe already treated for colon cancer to predict the outcomes,” Miller added. “The next step, here at Ohio State, was to use the algo rhythm on patients we had already treated, in which we knew the outcomes, and to see if the algo rhythm could accurately predict the outcomes … and it did a pretty good job.” Understanding and predicting the severity of a patient’s colon cancer and whether or not chemotherapy is needed after surgery has traditionally been the role of pathologists, in consultation with a patient’s oncologist. “We are the doctors who give a diagnosis by looking at the cells under a microscope traditionally [and now with digitized pathology],” Arole said. The James is a world leader in adopting and utilizing digital pathology. AI is the next step forward. “It’s like having a second set of eyes,” Arole said. The work is in the clinical trails stage and has great potential. “The first goal was to validate the findings from Norway here in the United States,” Miller said. “The next goal is to increase the patient numbers and make sure the results still stand.” Miller is optimistic the AI algo rhythm will continue to “learn” and help him and his James colleagues better understand which patients need the additional chemotherapy and which ones don’t.

The mission of Chyke Doubeni, MD, MPH, is clear. “I believe everyone deserves the right and opportunity to get the best care possible and I believe people who have socioeconomic and other barriers need not be prevented from getting that care,” said the Wexner Medical Center’s Chief Health Equity Officer and the OSUCCC- James Associate Director for Diversity, Equity and Inclusion. “All of us at the Wexner and James are very motivated by our mission to insure that everyone in Ohio has the best healthcare possible.” Dr. Doubeni is a family doctor and his research focuses on the effectiveness of screenings, such as colonoscopies, lung cancer and breast cancer screenings and recognizing and overcoming the social determinants of health. “These social factors are major contributors to poor health outcomes for underserved communities and understanding and addressing these barriers is crucial and my role is to create the processes to allow us to do this with better fidelity,” he said. His goal for the James is to provide better educational, screening, testing and treatment options to underserved populations in Columbus and in rural areas of Ohio, such as Appalachia. One of the ways to do this, Doubeni explained, “is to go to people where they are … with our mobile lung cancer van, our mobile breast cancer van and a free colonoscopy program run by the staff of the Wexner and James who volunteer their time.” Colon cancer screenings are another important area. The James is in the midst of what Dr. Doubeni called a pilot program in which people are given a fecal immunochemical test (FIT) that that is not invasive and that they can take at home to detect this all-too common type of cancer. “Our hope is to reach even more people who wouldn’t otherwise be screened,” he said. The James is also leading the way in using circulating tumor DNA to detect cancer in its early stages. “We have found ways to use a liquid biopsy, a blood sample, to detect cancer in the blood,” Dr. Doubeni said. This type of screening is still in the early stages, shows great promise and could be effective in reaching underserved populations.

The OSUCCC-James has one of the largest and most comprehensive blood and bone marrow transplant (BMT) and cellular therapy programs in the country, led by Marco de Lima, MD. “You want to cure everyone, period and we work toward that,” de Lima said, as he explained what drives him to find better treatment options for patients. “That’s the motivation and the only currency that matters, and that’s helping people.” Dr. de Lima described three new programs designed to help patients in Ohio and beyond: providing bone and blood marrow transplants (BMTs) and chimeric antigen receptor (CAR) T-cell therapy on an outpatient basis; engineering the genetic modifications of the cells used in CAR T-cell therapy inhouse; and a partnership to expand cellular therapy programs in Brazil. In the CAR T-cell process, T cells (the cells that fight cancer) are removed from a patient and reengineered in a lab to make them more efficient in recognizing and killing cancer cells. They are then put back into the patient to do their job. In the past, patients were admitted to the James during BMT and CAR T-cell treatments “and their stay was three to five weeks, in relative isolation,” de Lima explained, adding that “our ability to prevent infections, safer chemotherapies have set the stage where we don’t have to admit some patients … We will continue to offer inpatient options but will expand the option of coming here daily instead of being admitted to the hospital.” About 20 patients have undergone CAR T-cell treatment on an outpatient basis already. “Of these, 40 percent never needed admission to the hospital and the other 60 percent had their admission times dramatically reduced,” de Lima said. “We want to increase the percentage who will never see the inside of a hospital.” In the past, it took up to two months to send and receive back a patient’s re-engineered T cells from labs located throughout the country. “That’s too long,” de Lima said and then explained that the OSUCCC – James can now re-engineer the T cells inhouse. “We’ve currently treated 14 patients in a clinical trial and it’s taken us seven days from collecting the cells to giving them back to the patient,” he said. Dr. de Lima also described a partnership with Caring Cross (an organization devoted to providing medical services to underserved populations around the world) and Brazilian health officials. Members of de Lima’s team at the James will provide the technical expertise and training to create mobile clean rooms in Brazil that will re-engineer cells for CAR T-cell treatment. “This is a very ambitious program to provide CAR T-cell for free within the Brazilian healthcare system,” de Lima said.

The James has one of the largest head and neck cancer departments in the country, featuring experts in robotic and reconstructive surgery, proton radiation, chemotherapy and immunotherapy treatments, as well as cutting-edge clinical trials. “The key is you need a huge support network [of nurses, therapists and other specialists] to get patients through surgery, radiation, chemotherapy and immunotherapy … we have a team of more than 200,” said Matthew Old, MD, director of the James Department of Otolaryngology – Head and Neck Surgery. Any cancer above the clavicle, except for brain tumors, are head and neck cancers. The number of head and neck cancer cases is on the rise, Old said, adding the reason is the prevalence of the human papillomavirus in adults. “We’ll see an increased rate for the next 10 to 15 years because the HPV vaccine wasn’t available a few decades ago … HPV is the cause of about half the head and neck cancers we see.” James surgeons perform about 350 transplants a year for their head and neck cancer patients. “We are all cross trained in reconstructive surgery,” Old said. “We can take tissue and bone from a patient’s body and use it to reconstruct their tongue, mouth, jaw, any type of defect.” Old said that between 50 and 60 head and neck cancer patients receive radiation therapy daily at the James. The James is one of the few cancer hospitals offering proton radiation and it’s “more precise and we think it minimizes the long-term consequences to the patient,” Old said. There are about 20 head and neck cancer clinical trials at the James. In one trial initiated by James physicians and scientists, patients receive immunotherapy before surgery. “This is done to prime the immune system to recognize the cancer cells as foreign,” Old said. “Then after surgery, the patient receives a year of immunotherapy.” In another clinical trial, James doctors utilize circulating tumor DNA to determine the effectiveness of treatment for their patients. “We can watch their response to treatment and tailor the treatment accordingly,” Old said.