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.”

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.