Advances in genetic analysis, bone marrow transplants and cellular therapies have helped the leukemia specialist at the OSUCCC – James attain better outcomes for patients with blood cancers. “When a patient comes in, we get a sample from their bone marrow to know the genetics of their leukemia,” said Dr. Sumithira Vasu. “We want to know what is causing the leukemia to grow, and cause so much damage, and these genetics help us decide is this leukemia likely to be cured with chemo alone or does it need a bone marrow transplant … or cellular therapy.” In this episode Vasu explains the history and advances that have been made in bone marrow transplants, including the drugs that greatly reduce the effects of Graft-versus-host disease that plagued early transplants. New, cellular therapies, such as chimeric antigen receptor T cell (CAR T-Cell therapy) have shown great promise and the OSUCCC – James is a national leader in this game-changing treatment. “We take stem cells out of the body of a patient or a donor, send them to the lab and super charge them [through genetic modification] and then put them back in the patient’s body,” Vasu explained. These new super-charged T cells found in the body’s immune system can now better detect, target and kill the cancer cells in the blood. These super-charged T cells hunt for CD19, a protein that binds itself to the outside of cancer cells and has tricked the immune system into leaving them alone. “Now, because of the gene modification, they recognize the CD19,” Vasu said. The OSUCCC – James was one of a small group of comprehensive cancer centers that conducted the first clinical trials using CAR T-Cell therapy. And now, Vasu and her colleagues are among the leaders in the next step in the promising process. In the past, the bone marrow taken from patients was sent to a lab across the country for the genetic kick start. “Now, we are one of only a handful of labs in the United States that have the capability of manufacturing these cells in our own lab,” Vasu said, adding OSUCCC – James researchers have also identified two other targets in leukemia cells to attack: CD20 and CD22.

Gina Sizemore, PhD, and her lab specialize in identifying the causes of metastatic breast cancer at the molecular level. One anomaly they have discovered in the microenvironment that exists in breast tissue is a protein called platelet-derived growth factor-B (PDGFB). In this new episode, Sizemore, an assistant professor in the Department of Radiation Oncology and a member of the Cancer Biology Program, explains that in some women with breast cancer “the PDGFB level is really high compared to a normal [non-cancerous] breast.” Further research found that a high level of PDGFB increases the odds that a patient’s breast cancer will metastasize and travel to the brain. This is an important discovery because “when this happens there is a very poor prognosis, the median survival rate is 10 or 11 months,” Sizemore said. “Something about PDGFB allows the cancer cells to travel to the brain more readily and grow, and if we can figure out why, we can target that and block that from happening or reduce it when it happens.”

Glioblastomas (GBMs) are the most common type of malignant brain tumor and are very aggressive, which means they grow quickly. The current treatment options are limited. “We’re interested in finding the targets that drive the proliferation of these cells, or their resistance to radiotherapy, and then manipulate this to increase the ability of radiotherapy to kill them, or make it so they no longer divide [and grow],” said Monica Venere, PhD, a member of the OSUCCC – James Cancer Biology program and an assistant professor of radiation oncology. In this episode, Venere explains the basics of GBMs: What they are and why they are so aggressive, and the current standard of care. She then describes the work of her lab, which is to identify new targets within the GBM cells to attack through chemotherapy and radiation. She is especially interested in mitosis, which is the final step in the division of cells from one to two. One of the targets that Venere and the members of her lab have identified is KIF11, which is expressed at a high rate in GBMs. “This is an indication the cancer cell is more dependent [on the KIF11],” she said, adding the next step is to target this protein “and see if we can get a higher cell kill.”

Early in his career, William Farrar, MD, learned an important lesson from his mentor, Arthur G. James, MD. “The patient comes first … and I practiced that through my entire career,” said Farrar, who recently retired after a remarkable 46-year career at the OSUCCC – James. In this episode, we spend some time with Farrar, who was CEO of the James Cancer Hospital when he retired. He talks about the impact and legacy of Dr. James and his multi-decade quest to create a cancer hospital in Columbus; the creation of the Stefanie Spielman Comprehensive Breast Center that Farrar led; and the amazing advances in treating cancer patients during his long career. “But we need to keep working and continue to move forward,” Farrar said, echoing another lesson he learned from Dr. James. Farrar was determined to become a surgeon from an early age, and he worked in hospitals in his hometown of Aurora, Illinois during his high school years. He was an outstanding multi-sport athlete and set a record that still stands at Illinois Wesleyan University: five interceptions in one game. He came to Ohio State in 1975 as a surgical resident. A few years later, Farrar was named the hospital’s first oncology surgical fellow. Farrar has performed about 20,000 cancer surgeries over the decades, treating every type of cancer except brain cancer, before he eventually specialized in breast cancer in the early 2000s. “It’s phenomenal to me the advances we’ve made [in treating patients], it’s mind boggling,” Farrar said of the development of advanced radiation therapy, chemotherapy, and immunotherapy. Over the decades, Farrar played an important role at the OSUCCC – James in leading the research, clinical trials and treatments that have helped develop these treatment options and improved the outcome for thousands of patients. He called his career “very gratifying,” adding that “a cancer journey for a patient is also a cancer journey for the doc.”

When David Carbone, MD, PhD, began treating lung cancer patients in the 1980s, “it wasn’t clear if anything helped survival.” However, over the past few decades the treatment options and results “have changed dramatically,” said the director of the James Thoracic Oncology Center. In this episode of the James Cancer Free World podcast, Carbone explains the advances made over the years: precision cancer medicine that targets specific mutations, and immunotherapy drugs that “turn on” the body’s own immune system to detect and attack cancer cells that had previously been hiding. “The immune system now sees something it couldn’t see before,” Carbone said. Another promising area of research is cellular therapy in which immune cells are genetically modified to be more powerful “and then infused back into the patient.” Carbone said that new targets and therapies are being discovered in labs at the OSUCCC – James on a regular basis. “It’s important to convey to patients that there is now hope,” he said.

David Carbone, MD, PhD, is determined to reduce the number of lung-cancer deaths. “Lung cancer is the number-one cause of cancer deaths for men and for women in this country, and worldwide,” said Carbone, a lung cancer expert and director of the James Thoracic Oncology Center. “That’s why lung-cancer screening is so important.” In this episode, Carbone discusses the new James mobile lung cancer screening unit, which will travel Ohio screening at-risk and underserved people. The goal is to diagnosis lung cancer in the very earliest of stages, when it is more treatable. This will lead to a reduction in the number of lung-cancer related deaths in Ohio. Smoking is the leading cause of lung cancer, leading to about 85 percent of all lung-cancer diagnoses, Carbone said. The at-risk population the mobile unit will screen is defined as people over 50 who have smoked the equivalent of a pack a day for 20 years and have quit smoking less than 15 years ago. “These are the people who are at the highest risk, but we are studying ways to broaden the criteria and screen more people,” Carbone said. Screening at-risk people is vital because a lung-cancer tumor “can reach a reasonable size, a softball size, and the person won’t feel anything, no cough, no symptoms,” Carbone explained, adding that symptoms don’t materialize until the lung cancer has metastasized, spread to other parts of the body and is very difficult to treat.

Where you live, work, play and pray can impact your health. In this episode, Samilia Obeng-Gyasi, MD, MPH, discusses research studies and clinical trials that have shown how the social determinants of health and the healthcare inequities that impact many lower-economic populations can lead to cancer diagnoses in the later stages and poorer outcomes. Obeng-Gyasi is a James surgical oncologist and a researcher who specializes in breast cancer. Her research focuses in on how a person’s income level and access to healthcare, as well as the financial and emotional stress of a cancer diagnosis and treatment, can result in more aggressive cancers, worse outcomes and even higher death rates. These issues are more pronounced in lower-income populations and among many minority groups, such as Black women.

For example … “We’ve found that women with no health insurance or Medicaid presented with more advanced stages of breast cancer and had a worse overall mortality rate than patients with private health insurance,” Obeng-Gyasi said. Other areas of her research look at the Allostatic load of breast cancer patients and how it impacts their long-term outcome. Allostatic load is a way to measure the cumulative burden of stress in a patient. “We’ve found that [cancer] patients with a higher Allostatic load have a higher risk of death from their cancer,” Obeng-Gyasi said, adding additional research is trying to determine if a person with a long-term, high Allostatic load would have an increased cancer risk. Another research study found that Black women with breast cancer have a higher rate of what Obeng-Gyasi calls a “rapid relapse.” As a result of these findings, Obeng-Gyasi has worked with Barbara Andersen, PhD, a James psychologist and an expert in reducing stress. “The results of the study are compelling,” Obeng-Gyasi said. “Patients who participated have a better chance of survival and a lower rate of their cancer coming back.”

The new HALT Clinic at the James is improving methods to detect blood cancers, and making earlier diagnoses possible. “The goal is to identify patients or people at higher risk of developing leukemia due to either an inherited genetic mutation or an acquitted genetic mutation,” says Uma Borate, MBBS, co-director of the cutting-edge clinic. In episode, Borate explains how advances in sequencing DNA have allowed scientists and physicians to identify leukemia in the very earliest stages, when it is most treatable. “We’ve also been able to identify patterns of mutations in families and [discover] inherited genetic disorders we weren’t aware of before.” The James, a world leader in researching and treating blood cancers “had all the building blocks in place” to create the Hematologic Abnormalities at risk of Leukemia Transformation (HALT) Clinic, adding that “I helped bring them together under one roof," she explained. Diagnosing a patient with a blood cancer in the early stages is important. “If you had asked me years ago if this would make a difference, I would have said no,” Borate said. “But now, with the advances we’ve made the answer is slowly becoming yes.”

Adrenal cancer is rare, difficult to detect and is often diagnosed in the later stages when it has metastasized. “That’s why it’s so important to have centers of excellence so patients have access to providers who are experts in treating this disease,” says Barbra Miller, MD, co-director of the James Multidisciplinary Adrenal Clinic, a world leader in treating this type of cancer. The body’s two adrenal glands sit above the kidneys. They are important organs as they produce several different hormones that regulate blood pressure and metabolism “and help other organs work successfully,” Miller said, adding that in most cases only one of the two adrenal glands is cancerous. For patients with metastatic adrenal cancer, the first treatment option is chemotherapy “so we can determine how it responds and how quickly it is growing and determine whether the resection (an adrenalectomy that removes the entire adrenal gland) is advantageous.” An adrenalectomy is a delicate procedure. “The tumor is very fragile and can grow through the capsule of the tumor into the surrounding organs and we don’t want to spread those cells [during surgery],” Miller said. “Once the surgery is completed, we look at the pathology to determine if other treatment is warranted.” A person can function quite well with one adrenal gland, Miller said. Because adrenal cancer is so rare, about 200 cases a year, according to the American Cancer Society, it is hard to attract funding for research. “We are constantly searching for funding, and Pelotonia is key to our program’s success in continuing to research this disease.”

A new clinical trial led by the James that utilizes immunotherapy is showing great promise in treating women with a recurrence of endometrial cancer (also called uterine cancer). In this episode, David O’Malley, MD, director of the James Division of Gynecologic Oncology and Co-Director of the Gyn Oncology Phase I Program, describes the trial and its great promise. Previously, “we had limited options and they had significant toxicity,” O’Malley said of women who had recurrent or metastatic endometrial cancer. In this new trial, women were treated with pembrolizumab (marketed as Keytruda) an immunotherapy used to treat several types of cancer and targets the cellular receptors cancer cells use to shield themselves from the body’s immune system. Removing these “blockers allows the immune system to identify and attack” the cancer cells,” O’Malley explains. There were 79 patients in the trial “and 48 percent responded markedly and 14 percent had a complete response and their cancer was completely gone,” O’Malley said.