The James Cancer-Free World Podcast The Ohio State University

Pelotonia has changed Joe Apgar’s life. “I’ll never forget how I felt in the moment someone told me I had cancer,” the CEO of Pelotonia said in this episode. “You feel completely lost and by yourself and you don’t have answers to the questions running around through your head.” Apgar was diagnosed with testicular cancer while a student at Penn State. Pelotonia is the fundraising cycling event that has raised more than $285 million for cancer research at the James. Apgar first rode in 2011, soon after he moved to Columbus to work for Rockbridge Capital, a private equity firm that sponsors a Pelotonia team Apgar helped create. “I remember standing at my first opening ceremony [of Pelotonia] and how uplifted and excited and supported I felt … that’s when I could flip the switch on it and feel empowered by my own story and experience,” Apgar said of the start of his first ride and crossing the finish line. Apgar talked about his cancer journey, how he connected with a James physician for his follow-up cancer care, his Pelotonia experiences as a rider and leader, and the future of the event. Apgar also talked about the importance of the Pelotonia “community” and how it has helped connect members of the James team with riders, volunteers and donors. “I think [the Pelotonia founders] hoped that some of this sense of community would happen, but I don’t think anyone could have dreamed it would happen at the scale it has,” he said.

Because adrenal cancer is so rare, very few cancer hospitals have specialists equipped to treat patients and perform research and offer clinical trials for this type of cancer. “Very few physicians ever see a case in their lifetime and so there are a lot of physicians out there who don’t really understand the disease process,” said Barbra Miller, MD, the co-director of the James Multidisciplinary Adrenal Clinic. “I want to make sure patients get good, consistent and comprehensive and safe care and as a surgeon I want to make sure every patient gets the best surgery.” In this episode, Miller and Priya Dedhia, MD, PhD, a James expert in adrenal surgery and research, discussed this rare form of cancer and the wide range of screening and treatment options at the James, and their cutting-edge research. There are currently no screening procedures, such as mammograms for breast cancer or colonoscopies for colon cancer. This means adrenal cancer is often first diagnosed in the later stages when it has metastasized and spread. “We don’t know there’s a tumor until it’s quite large or has gone somewhere else, and another way we know is if [the cancerous adrenal gland] overproduces hormones,” Miller said. Some of the research at the James is focused on understanding how benign tumors in the adrenals can become cancerous. “We know colon cancer starts as a benign polyp,” Miller said. “We never thought this was true with adrenal cancer but now we’re at the stage where we think we can prove this is true.” Surgery is the primary modality for treating adrenal cancer, often followed by chemotherapy or, in recent years, immunotherapy. “We’re working to create new models for adrenal cancer treatment,” Dedhia said, adding that in her lab she has created “organoids” that “are like patient avatars and help us better understand and treat the cancer.” Organoids are masses of cells grown in the lab and can be used to test the effectiveness of new drug treatments, such as immunotherapy, prior to clinical trials in patients. “We’ve found two new pathways that kill these organoid cells and the next step we’re hoping for is a clinical trial,” Dedhia said. “We believe we’ve found a way to improve the immune response [of new immunotherapy drugs] and we’re very excited.”

A breast cancer diagnosis in 2011 changed the life and career path of Jessica Winter. “It was a really defining moment in my career,” said Winter, PhD, an Ohio State professor of engineering, and a member of the Ohio State Cancer Engineering Center. “I could have kept doing research and publishing papers … but now I really wanted to do translational work and take something from the lab to patients.” Winter is a leader in the growing field of utilizing nanotechnology for cancer science and treatment. “There are three areas where it can be applied – imaging, biosensing and drug delivery,” she said. Winter and her lab, and her collaborators at the James and the Ohio State Cancer Engineering Center are involved in all three of these areas. Nanotechnology has been used since the 1990s to deliver chemotherapy drugs. “Nanotechnology is defined as something between the size of one and 100 nanometers,” Winter said. “You can fit five million nanoparticles that are five nanometers in diameter inside a cell.” In her lab, Winter has developed what she calls “quantum dots” to improve the delivery of drugs to cancer patients. Another area of her research involves biosensing. “The COVID test is a biosensor and some of the earliest biosensors were home-pregnancy tests,” Winter explained. Winter and collaborators at the James are also working on a nanotechnology biosensing method to analyze solid tumors. “We came up with a method of erasable labelling,” she said of the method in which several different colors, or layers, of can be used to create a series of images. “We need better diagnostic tests to match the patient with the best therapy, this is personalized medicine,” Winter said. Her cancer diagnosis (she is in remission and doing well) continues to motivate Winter. “I love my job and what I do,” she said. “The idea that I can help people … and make real things for real people is very exciting.”

Knowing your family’s medical history is important and can save lives. “When we think of family history in terms of cancer genetics [and inherited genetic mutations], we think about a broad spectrum of relatives, more than just your parents and siblings,” said Leigha Senter, MS, CGC, a James licensed genetic counselor. “We ask about grandparents and aunts and uncles and cousins and that can inform us about how likely you have a hereditary predisposition for cancer.” Ohio State and the James have one of the largest and most advanced genetic counseling programs in the country. “We have 12 genetic counselors on the faculty supporting the cancer program and we have genetic counselors who specialize in specific types of cancer,” Senter said. In this episode, Senter discusses the two most common types of inherited genetic mutations that increase the cancer risk: the Breast Cancer gene (BRCA1 and BRCA2) that increases the risk of breast cancer as well as ovarian, pancreas and prostate cancer; and Lynch Syndrome, which increases the risk of colorectal cancer as well as uterine cancer. “The average woman has a 12 percent chance over the course of their lifetime of developing breast cancer,” Senter said. “Those with [BRCA1 and BRCA2] have anywhere from a 50 to 80 percent chance.” Uncovering inherited genetic mutations leads to earlier and more frequent screenings that can detect cancer in its earliest and most treatable stages. In the case of patients with Lynch Syndrome, earlier and more frequent colonoscopies “can actually prevent a cancer from happening,” Senter said. Cascade testing is one of Senter’s specialties. “Someone in every family is always the first to test positive for an inherited genetic mutation,” she said. “The next step is to help them share this information with as many family members as possible. This is cascade testing and is where are real potential to help people is.”

The number of younger patients diagnosed with colorectal cancer is on the rise. “We always used to say at age 50 get your first colorectal screening, and now we’ve dropped that to 45,” said Samuel Akinyeye, MD, an Ohio State gastroenterologist. “And the reason is we’re seeing younger people being diagnosed with colorectal cancer … I’m seeing younger patients in my clinic.” In this episode, Akinyeye discusses several of the reasons for the increase, including the impact of unhealthy diets and sedentary lifestyles, and the role of family history and inherited genetic mutations that increase the risk of colorectal cancer. “We’re eating more processed foods and greasy, fatty foods that are pro-inflammatory,” he said, adding obesity and inflammation increase the risk of cancer. He also talks about the importance of screenings, such as colonoscopies, and how they can reduce the number of colorectal cancer diagnoses and deaths. “Colonoscopies are the gold standard of screening,” Akinyeye said, adding they detect and pre-cancerous polyps that are then removed before they actually become cancerour and spread to other parts of the body. “Screenings save lives,” he said. Knowing your family history and discussing it with your primary care physician is vital. “We have a saying, that family secrets kill families,” Akinyeye said, adding people with a family history of colorectal cancer or even high-risk polyps should start screenings even earlier than 45. “People aren’t getting screened as early as necessary because they’re not aware of their family history.” Inherited genetic mutation, such as Lynch Syndrome, “greatly increase the chances of developing colorectal cancer and other types of cancer,” Akinyeye said.

To kick off Pelotonia 2024 Launch Week, this is a special re-release of episode 155, “The Next Leaps Forward in Cancer Treatment, with Guest Co-Host Raph Pollock.” The new version of this episode now includes an introduction and conclusion from Joe Apgar, Pelotonia CEO. Each of the James scientists and physicians featured in this episode has been funded by Pelotonia. Hearing directly from these individuals about the continued progress, groundbreaking research, and treatment advancements is inspiring as the Pelotonia movement kicks off its 16th year. Pelotonia's cycling events for 2024 are Ride Weekend on August 3-4 and Gravel Day on September 28, 2024. Riders, Volunteers, and Challengers can sign up and commit to continue funding the work of James scientists and physicians like those you will hear from in this episode. Registration for Pelotonia 2024 opens on February 29 at Pelotonia.org/register.