Dialogue | 2017 | Volume 1

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2017 Volume I

Wilmot Cancer Institute | University of Rochester Medical Center

At the Forefront A new option for advanced colorectal cancer p. 4


Le tt e r f rom t h e Di re ct or Hello Friends of Wilmot Cancer Institute,

Jonathan W. Friedberg, M.D., M.M.Sc. Director, Wilmot Cancer Institute

Every week, I am amazed at the passion that our communities have for supporting advances in cancer care and research in our region. I see it in the 5K races, golf tournaments, lemonade stands and other activities organized by families and friends to support Wilmot’s mission. I see it in the gifts, large and small, that come from individuals and in the excitement of major events such as Wilmot’s annual Discovery Ball, held each spring. The record-setting support from this year’s Discovery Ball (see Page 23) inspires me, and our entire team at Wilmot, to work harder toward a cancer cure. This kind of community support allows us to do some amazing work. In this issue of Dialogue, for example, you’ll read about our lymphoma program and the international impact we’re having on the way these cancers of the immune system are treated. Our group is routinely recognized as a clinical trial leader in lymphomas, meaning novel therapies are available to patients in our region often years before FDA approval. As a member of this team, I take particular pride in their efforts and in the program’s evolution. Our success involves literally dozens of people, including nurses, social workers, lab technicians and others, all of whom are uniquely focused on both the clinical care of patients with lymphoma and research to move the field forward. Evidence of our reputation includes several high-profile presentations by Wilmot investigators this month at the International Conference on Malignant Lymphoma in Lugano, Switzerland. As we work toward achieving National Cancer Institute designation, further investment in programs like lymphoma is needed. We have a very busy year ahead of us at Wilmot, with ongoing recruitment of several laboratory-based investigators and improvements to our research infrastructure on a variety of levels. Our success in these initiatives is directly related to the generosity of our community. I thank you for your interest and support.

Jonathan W. Friedberg, M.D., M.M.Sc.

On the Cover

UR Medicine’s Roberto Hernandez-Alejandro, M.D., is one of the few liver surgeons in North America who can perform the innovative ALPPS procedure successfully. Cover photo: Matt Wittmeyer The Wilmot Cancer Institute is a component of Strong Memorial Hospital.

Wilmot Cancer Institute National Advisory Board Members 2017 Richard DiMarzo, chair Dick Bell Elaine Bucci Michael Buckley Rina Chessin Michael Crumb Patrick Cunningham James Hammer Robert Kessler Kathy Landers Michael Linehan Alyssa Lozipone Jett Mehta Carol Mullin Walter Parkes Barbara Pluta-Randall Mary Pluta Ronald Pluta

Donald Rhoda Steve Whitman Dennis Wilmot Paul Wilmot Richard Yates Faculty Members Yuhchyau Chen, M.D., Ph.D. Aram F. Hezel, M.D. Christian Peyre, M.D. Gary Morrow, Ph.D., M.S. Emeritus Members Judy Linehan Jim Ryan, Jr. Ex-Officio Members Jonathan W. Friedberg, M.D., M.M.Sc. Hartmut “Hucky” Land, Ph.D. David C. Linehan, M.D.

Kristie Robertson-Coyne Mark Taubman, M.D. Honorary Board Members Dr. George Abraham Elaine Del Monte Michael Donnelly Joan Feinbloom Janet Felosky Paul Hanrahan Gary Haseley Mark Kokanovich Frank and Cricket Luellen Sandra Hawks Lloyd Ronald Maggio Steve McCluski Michael Norris Jeff Pierce Larry Rabinowitz Gregory Smith David Vigren Philip Wehrheim

Timothy Williams Timothy Wilmot Thomas and Colleen Wilmot Bruce Zicari, II

Dialogue Editor / Writer Lydia Fernandez, Senior Public Relations Associate (585) 276-5788 Contributing Writers Ruth Harper-Rhode Leslie Orr Art Director / Designer Heather Deal Feature Photography Matt Wittmeyer Jan Regan


CONTENTS COVER STORY

Finding Hope and Time James Bowman had few choices to treat the colorectal cancer that had spread throughout his liver. A complex surgical procedure called ALPPS, however, gave him a new option.

2017 Volume I

10 Pushing Ahead Wilmot’s lymphoma program tackles the challenge of prediction and the promise of precision medicine.

15 In Motion Physical activity, once considered unsafe for people with cancer, proves important before, during and after treatment.

20 Family Matters Wilmot’s new Hereditary Cancer Screening and Risk Reduction clinic is helping families who have inherited cancer syndromes.

2 News Briefs 22 Community Focus 23 Discovery Ball 2017

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NEWS BRIEFS

"Chemo-brain" Among Women with Breast Cancer is Pervasive The largest study to date of cancerrelated cognitive impairment shows that women with breast cancer report it’s a substantial problem after chemotherapy for as long as six months after treatment, according to Wilmot Cancer Institute investigators. Scientists have known that chemo-brain, which includes problems with memory, attention, and processing information, is an important issue for patients. Yet limitations in previous studies have left several questions about when and why it occurs and who is most likely to develop the condition. The Wilmot research was published in the Journal of Clinical Oncology and recently cited as one of the best articles for 2017. Led by Michelle C. Janelsins, Ph.D., scientists compared cognitive difficulties among 581 breast cancer patients treated at clinical sites across the U.S. and 364 healthy people, with a mean age of 53 years in both groups. Researchers used a specialized tool called FACT-Cog, a well-validated measurement of cognitive impairment that examines a person's own perceived

impairment, as well as cognitive impairment perceived by others. Their goal was to discover whether persistent symptoms existed and to possibly correlate them with other factors such as age, education, race, and menopausal status, for example. Investigators found that compared to healthy people, the FACT-Cog scores of women with breast cancer exhibited 45 percent more impairment. In fact, over a period of nearly a year — from diagnosis and pre-chemotherapy to post-chemotherapy follow-up at six months — 36.5 percent of women reported a decline in scores compared to 13.6 percent of the healthy women, the study said. Having more anxiety and depressive symptoms at the onset led to a greater impact on the FACT-Cog scores. Other factors that influenced cognitive decline were younger age and black race. Women who received hormone therapy and/or radiation treatment after chemotherapy had similar cognitive problems to women who received chemotherapy alone, the study noted.

“Our study, from one of the largest nationwide studies to date, shows that cancerrelated cognitive problems are a substantial and pervasive issue for many women with breast cancer,” said Janelsins, assistant professor of Surgery in Wilmot’s Cancer Control and Survivorship program. She is also director of the program’s Psychoneuroimmunology Laboratory. The National Institutes of Health and the National Cancer Institute funded the study.

Wilmot Cancer Research Day Raises $17,000 for Cancer Research More than 200 donors gave nearly $17,000 on Wilmot Cancer Research Day held Jan. 25 in the Strong Memorial Hospital Lobby. For this telethon-style event, Wilmot partnered with 13WHAM and FOX Rochester. Stories and interviews aired during the morning and evening news broadcasts. Funds donated during these events go toward important seed grants that help researchers conduct initial studies of questions related to cancer care and biology. This enables scientists to gather more evidence that could lead to securing a larger amount of funds for further research from government agencies like the National Cancer Institute.

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“We’re so grateful for everyone who made this day of giving possible, from the volunteers who gave their time to the many donors throughout the region who gave a donation,” said Tiffany Paine-Cirrincione, associate director of Advancement and Community Events for Wilmot Cancer Institute. “These funds play an important role as Wilmot’s researchers work to find better ways to treat cancer.” This event is one of two premier community fundraising events Wilmot holds annually; the other is the Wilmot Warrior Walk, which takes place Sept. 10 this year.


Wilmot Discovery Improves Use of Umbilical Cord Blood as Cancer Therapy Wilmot clinician/scientist Omar Aljitawi, M.D., has found that a hormone called erythropoietin (EPO) plays a critical role in umbilical cord blood transplants for leukemia and lymphoma patients. Umbilical cord blood is a rich source of stem cells for transplantation for patients lacking a matched donor, but it takes longer to migrate to the bone marrow and fewer cells reach their target. Aljitawi’s goal was to understand the cellular signals that regulate blood cell homing to improve cord-blood engraftment. He conducted a small clinical trial — the first human trial of its kind — and found that lowering EPO levels aids in a process called homing, where newly transplanted blood stem cells migrate properly to the bone marrow and begin to restore the

body’s ability to make healthy blood and immune cells. His finding was recently published in the journal Blood. In the clinical trial involving 15 patients, researchers blocked EPO signaling by delivering hyperbaric oxygen therapy to cancer patients before the cord-blood transplant. The oxygen therapy involves a patient entering a specialized chamber and breathing 100 percent oxygen. The study found this method was safe and well-tolerated by patients, and that it lowered EPO levels. Compared to other patients who had not received oxygen therapy, the clinical trial volunteers also recovered their blood counts earlier and became independent from blood transfusions earlier in their course of recovery. Aljitawi recently joined the Wilmot faculty, and he is developing a phase II study in Rochester to further explore the use of hyperbaric oxygen in umbilical cord blood transplantation.

Ann and Carl Myers Cancer Center Opens in Dansville After two years of planning and construction, Wilmot’s Ann and Carl Myers Cancer Center opened in Dansville earlier this year. Established with a $2 million gift from Ann and Carl Myers of Springwater, Livingston County, the project features a 4,500-squarefoot lower level addition housing a radiation oncology clinic, and a 2,300-square-foot medical oncology clinic featuring three exam rooms and five chemotherapy/infusion chairs on the first floor. The regional cancer center will also provide patients with access to services including advanced diagnostic testing, clinical trials, outpatient palliative care, and Wilmot Cancer Institute’s Judy DiMarzo Cancer Survivorship Program. “The opening of the Ann and Carl Myers Cancer Center reflects the community’s investment not just in the construction of this building, but also in transforming cancer care across the region,” says Jonathan W. Friedberg, M.D., M.M.Sc., director of Wilmot Cancer Institute. A collaboration of Wilmot, Noyes Health and Jones Memorial Hospital, the Myers Cancer Center serves as a hub for oncology services, and it includes medical oncology services at Jones Memorial Hospital in Wellsville and a clinic in Hornell.

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Hope and time Complex, innovative procedure offers new option for metastatic colorectal cancer By Lydia Fernandez

James and Ruby Bowman of Penfield, N.Y., chose the ALPPS procedure to treat his metastatic colorectal cancer.

James Bowman wanted to know his choices. When he learned last summer that his colon cancer had spread extensively in his liver, he sought opinions in Rochester, New York City, Chicago and Texas.

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“ALPPS is the most innovative advance in liver surgery over the last decade.” -Roberto Hernandez-Alejandro, M.D.

Because every segment of his liver was riddled with tumors, conventional liver surgery was not an option. It wouldn’t leave him with enough healthy liver to survive. He could get chemotherapy to try to control the cancer, but that would buy him only months to a few years. “My journey was going to be on a narrow path,” Bowman, 71, of Penfield, recalls. “I was not going to have a wide range of options.” Richard Dunne, M.D., his medical oncologist at Wilmot Cancer Institute, and liver surgeon Roberto Hernandez-Alejandro, M.D., UR Medicine’s chief of Solid Organ Transplantation, saw another possibility for Bowman — aggressive chemotherapy to prevent his cancer from spreading further and a relatively new operation known as ALPPS, or associating liver partition and portal vein ligation for staged hepatectomy. At the time, fewer than 1,000 people in the world had undergone this high-risk procedure, and Hernandez-Alejandro, one of the only surgeons in North America who

can perform ALPPS successfully, had done 38 of these operations with good results. Despite its serious risks, ALPPS held the promise of more time, better quality of life and a potential cure for Bowman, who was otherwise in good health. His choice became clear: “In life or in death, this was the way I was going to go.” “I had one year, maybe,” he says, recalling his initial prognosis. “Now, I have hope and time.”

An innovative procedure Colorectal cancer is the third most common cancer diagnosed among men and women in the United States. About half of those cancers spread to the liver, the largest organ inside the body. The liver is responsible for several essential functions, including the breakdown and absorption of nutrients and filtering toxic substances from the blood. If the liver is unable to function properly, it can be fatal. "If you can control the disease in the liver, you can affect overall survival," says

David Linehan, M.D., chair of Surgery and Wilmot’s co-director of clinical operations. When colorectal cancer has spread to the liver, surgery is the only avenue for potential cure. Until now, if the cancer had spread throughout the liver, removing the tumors would not be possible. “Normally, we couldn’t take these patients into the operating room because if we remove all of the cancer, we leave only a very small portion of liver, and they would die of liver failure,” Hernandez-Alejandro says. The ALPPS procedure, however, stimulates the liver’s unique ability to regenerate itself and accelerates that process, helping to offset the removal of the cancer. “ALPPS is the most innovative advance in liver surgery over the last decade,” says Hernandez-Alejandro, who has been doing the procedure for five years. The procedure was developed in Germany several years ago, and surgeons elsewhere have been slowly adopting it. In this two-stage operation, the large, diseased section of liver is separated from

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Roberto Hernandez-Alejandro, M.D., left, is UR Medicine's chief of Solid Organ Transplantation and one of the only surgeons in North America who can perform the ALPPS procedure successfully.

a small healthier portion. The surgeon diverts the majority of the liver’s blood supply to that small portion, triggering the rapid regeneration of the organ. Although separated, both sections remain in the body for seven to 10 days. In that period, the smaller section of liver grows rapidly and can almost double its size, a process called hypertrophy. Meanwhile, the diseased liver continues to function, preventing liver failure. Once the healthy liver is large enough to take over, the patient returns to the operating room, and the diseased part is removed. That healthy portion of liver will continue to grow, though more slowly. After three to four months, it will reach about 70 percent of its original size and function at close to normal capacity.

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The ALPPS procedure requires close collaboration with a patient’s medical oncology team. Patients at Wilmot undergo a course of chemotherapy prior to this surgery to control the cancer where it is, prevent it from spreading further and sometimes to shrink the size of the tumor. But it’s a delicate balance, as chemo can cause liver damage, and patients need as much healthy liver as possible to undergo ALPPS. “We try to choose those regimens that may have less effect on the liver,” Dunne says. “In recent years, we’ve seen the effectiveness of chemotherapy improve with the use of targeted antibodies. Better response rates have allowed patients to undergo surgical resection and give more patients a hope for cure. The ALPPS procedure takes this one step

further, as it presents opportunities for surgery in patients in whom we previously thought surgery was not possible.”

Not by chance In August, Dunne presented Bowman’s case to his colleagues at Wilmot’s weekly tumor board conference. Experts from pathology, radiology, surgery, medical oncology and radiation oncology reviewed Bowman’s diagnosis and debated the possibilities for treatment. Hernandez-Alejandro, who had come to Rochester just a few months before, saw the scans of Bowman’s liver and recognized him as a potential candidate for ALPPS. The cancer was quite advanced, and Hernandez-Alejandro needed to see that it responded to


Richard Dunne, M.D.

chemotherapy before he would operate. Dunne called Bowman right after the meeting to explain that ALPPS was an option, and Bowman knew this was what he had to do. “It was very clear to me that this was God’s providence,” says Bowman, who has strong faith. “Providence means that the hand of God is in the glove of human events. Our meeting was not by chance.” He started chemotherapy the following week. After four rounds, Bowman and his wife Ruby met Hernandez-Alejandro, and they felt an immediate connection. The Bowmans appreciated Hernandez-Alejandro’s candor about his experience, the risks and benefits of ALPPS, and what life after the procedure could hold. The surgeon was impressed by Bowman’s passion for life and motivation. “Don’t give me any false hopes here,” Bowman told him. “I just need to live with what’s real.” “The easiest thing is not to do the surgery,” Hernandez-Alejandro tells his ALPPS patients. “The other thing is to do this surgery. There’s a small chance of being cured and a good chance of surviving for more time with better quality of life. There’s also a small chance of dying and a chance that your cancer will come back. The only way to know is to go through this procedure, but you have to be prepared. I

David Linehan, M.D.

am prepared.” He told Bowman to be strong, to be a warrior, to eat healthy. Bowman began to focus on building his strength before surgery. He and his wife met with the team at Wilmot’s PEAK Lab, where clinical exercise physiologist Michelle Porto created a personalized plan, and they also met with Joanna Lipp, one of Wilmot’s specialized registered dietitians. “You just do what you have to do,” Bowman says. “You rely on your faith and people you can trust.” He underwent the first stage of his surgery on Nov. 30. In the six-hour operation, Hernandez-Alejandro separated 85 percent of Bowman’s liver from a very small healthy remnant. That remnant, about the size of a medium apple, was one of the smallest that Hernandez-Alejandro had ever worked with. It was less than half the volume of liver that Bowman would need to survive. In the waiting room, Bowman’s wife Ruby prayed, “Save this one good man.” “It was not just a prayer,” she says. “I was challenging God.” After the operation, HernandezAlejandro told her that he was confident, but that he was also concerned about the small size of the healthy liver. A few days later, Hernandez-Alejandro visited Bowman in the hospital. He was

impressed to see his patient using his computer, and he knew that Bowman’s liver was growing stronger. Liver failure would have left him too weak and confused even to send an email. In just over a week, Bowman’s apple-sized liver doubled in size, and on Dec. 12, Hernandez-Alejandro completed the second half of the operation. Bowman went home eight days later. “I just knew I was going to be OK,” he says.

Serious risks, major rewards Because of its complexity and risks, ALPPS is appropriate only for certain patients with metastatic colorectal cancer. They have to be well enough for surgery and have no background of liver disease such as hepatitis or cirrhosis. A small portion of the left side of their liver must be free of cancer and have an independent blood supply. Their cancer should also be responsive to chemotherapy. The skill and experience of the surgeon are the key factors in the success of ALPPS. Because it is so technically challenging and still new, very few centers in the United States offer the procedure. Wilmot is one of the only places in the country to offer ALPPS.

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The ALPPS Procedure 1. In the first stage of this procedure, the surgeon removes any tumors from the smaller lobe of the liver and separates it, diverting blood flow, from the larger lobe. 2. Over the next 7 to 10 days, the smaller lobe of liver grows rapidly, while the larger diseased portion of liver continues to function, preventing liver failure. 3. In the second stage of the operation, the larger, diseased portion of liver is removed. By then, the small remnant of liver has grown large enough to take over function for the entire body.

“This type of complex and risky surgery really needs to be done by surgeons in centers with the highest level of expertise,” Linehan says. “To my knowledge, Dr. Hernandez-Alejandro has the largest experience in North America with the ALPPS procedure, and his results are outstanding.” Serious, sometimes fatal, complications of ALPPS include bile leaks and sepsis. About 12 percent to 15 percent of those who have undergone ALPPS worldwide have died within three months of surgery. Hernandez-Alejandro’s patients experience relatively few complications, and so far, none have died within 90 days of surgery. “Without this surgery, the majority

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of these patients would die within a year or perhaps a year and a half,” Hernandez-Alejandro says. “With it, more than 50 percent are alive at three years, and those who do not reach the three years have extended their survival with better quality of life.” Some ALPPS patients see their cancers return, but with close follow-up, these metastatic tumors are often found early. Depending on the tumors’ size and location, additional surgery may still be possible. “If the cancer comes back, it’s like resetting the clock,” he explains, because patients have options that would not be available if they had not undergone the procedure.

Even if the cancer does not return, patients may undergo chemotherapy following surgery, though there is no guarantee that after ALPPS they will be able to tolerate it with a smaller liver. The high rate of major complications, the likelihood of the cancer’s recurrence and the potentially limited options for additional treatment make ALPPS controversial among oncologists. Others, however, contend that patients with advanced cancer should keep all their options on the table, especially with the growing evidence of the procedure’s benefits. “It’s a very aggressive approach,” medical oncologist Dunne says. “Without surgery, most of these patients


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CT scans of the liver: 1. Before ALPPS, tumors, which appear as dark spots, are found throughout the liver, shown here in red. 2. After the first stage of ALPPS, the divide between the two sides of the liver is visible, and the smaller left liver is already growing. 3. Six months after the ALPPS procedure is completed, the liver remnant has grown significantly, reaching about 60 percent of the volume of the original organ.

would be on and off chemotherapy for the rest of their lives. Even if their cancer recurs, ALPPS patients live longer. The surgery gives them an option potentially for additional time off chemotherapy, and with that, their quality of life is improved.” Although relatively few people have undergone ALPPS, Hernandez-Alejandro and his colleagues around the world are studying what life is like after surgery for their patients. In addition to long-term clinical and oncological outcomes, they are looking at emotional well-being, social functioning and overall health status. They have so far found that ALPPS patients report their quality of life to be similar to that reported in surveys of the general population.

“A lot of them are retired and want to enjoy life with their families. They want to play golf and go to their grandchildren’s weddings,” Hernandez-Alejandro says. “ALPPS, when indicated, can offer this to patients. A few years ago, we couldn’t have imagined offering them surgery.”

Hope for 10 more years For Bowman, life after ALPPS includes plans to spend a month in Akron with his young granddaughters. Once he’s finished with his post-surgery chemotherapy, he’ll get to see their recitals and once again be their “G-Daddy,” as they call him. He and Ruby are planning a trip to Bermuda, where they have extended family, and he’ll

soon be back at church, where he is an organist. “And maybe in 2018, we can take that trip to Europe that we put off,” Ruby says. “I’m still challenging God,” she adds. “I want 10 more years.” “I don’t know what my course will be, but this has given me hope and time,” Bowman says. “We appreciate every sunset, every sunrise and every noon-day in a new kind of way. It has a whole different texture and richness.”

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Precision medicine, national leadership in lymphoma By Lydia Fernandez

Despite his aggressive, incurable lymphoma, Steve Corey gets out on the golf course every week with friends.

At 74, Steve Corey refuses to give up anything. Despite his aggressive, incurable lymphoma, he gets out on the golf course every week, weather permitting. The retired engineering tech also keeps himself busy with his family and their camp. Diagnosed with diffuse large B-cell lymphoma in 2014, Corey participated in a clinical trial at Wilmot Cancer Institute that put him in remission for nine months. When his cancer came back, his oncologist, Carla Casulo, M.D., laid out his options. He chose a new targeted therapy that has kept his cancer at bay so far. “The pill I’m taking could stop working next week,” says Corey, who lives in Penn Yan, N.Y. “But every day it keeps the cancer from coming back is

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is another day for someone to pour something from one vial into another and maybe find an answer.” Wilmot’s lymphoma program is helping to lead the search for those answers. They are collaborating with experts in fields such as immunology and hematopathology to understand better how these cancers of the immune system behave. They’re looking for answers in the biology of these diseases —in the molecular make-up of tumors and in the non-malignant cells that surround these cancers. They’re also testing novel therapies and therapeutic combinations to find ways to make them more effective without making them more toxic. Their work is shaping the way lymphomas are treated around the world. “We can now apply basic scientific

knowledge of these diseases to make a precise diagnosis and can often go one step further to use targeted therapy to control the specific lymphoma affecting a patient,” says Clive Zent, M.D., who leads Wilmot’s lymphoma team.

Challenge of prediction Over the last 20 years, researchers have been uncovering the complexity of lymphoma and the challenges it presents for treatment. The term “lymphoma” applies to more than 60 diseases with very distinct characteristics. Some of these cancers grow slowly, and some are aggressive. Some require immediate treatment, while others need only active surveillance and supportive management


unless they progress. Some respond well to standard therapies, but others don’t. And sometimes, they change from one type of lymphoma to another. Their behavior often can’t be predicted at diagnosis, which complicates choosing the best course of action. In follicular lymphoma, for example, many patients will not require treatment for several years and often respond well when initial therapy is started. Although most follicular lymphomas are not curable with current therapy, patients with this disease can live for decades with this slow-growing cancer, even if their disease returns later. However, in a study that has garnered international attention, Wilmot oncologist Carla Casulo, M.D., identified that about 20 percent of people with this common non-Hodgkin lymphoma relapse within two years. There’s no way to identify them before their cancer comes back. Casulo was also able to establish that patients who relapse early also have poor survival outcomes. Her study showed that about half of them will die within five years — regardless of which treatments they receive — a finding that brought urgency to addressing these patients’ needs. “We can’t wait two years to find out whether they will relapse or not,” Casulo says. “We need to identify them at diagnosis.” Her findings have been validated by researchers around the world, and they have prompted a flurry of studies to find out more about what makes these patients different and what treatments will be most effective for them. Casulo is continuing to study this group, collaborating with hematopathologist Richard Burack, M.D., Ph.D., to identify the biologic characteristics of these patients using samples from Wilmot’s own tissue bank. Beyond Rochester, the National Cancer Institute’s Lymphoma Steering Committee has designated this early-relapse group a priority population for further dedicated study on a national scale. As part of that effort, Wilmot hematologist Paul Barr, M.D., is designing the largest cooperative group clinical trial in the country focused on these patients. This randomized, phase 2 study will be conducted at Wilmot and many other cancer centers nationwide led by NCI’s National Clinical Trials Network. It will compare standard chemotherapy with two novel treatment strategies for patients who relapse early. “Making follicular lymphoma a manageable chronic disease for more patients — or even curable for some — is possible in our lifetime,” Barr says.

Looking for clues in the immune system

Richard Burack, M.D., Ph.D.

In lymphoma, the non-cancer cells in a tumor — known as the tumor microenvironment — play an important role in the course of the disease. “Tumors don’t grow by themselves in the body,” explains Wilmot hematopathologist Richard Burack, M.D., Ph.D. “They have a lot of other cells mixed in with them, and the non-malignant part of a tumor is a powerful determinant of how these tumors will behave.” Lymphoma is a cancer of the immune system, and lymphoma’s microenvironment is made up of other immune cells. Its composition can influence the course of a patient’s disease and how patients respond to treatment. To analyze these cells and their role, Burack has teamed up with Tim Mosmann, Ph.D., who directs the University of Rochester Medical Center’s Human Immunology Center and David H. Smith Center for Vaccine Biology and Immunology. They are testing if the type and number of immune cells in the blood predict the immune cells of the lymphoma’s microenvironment. Because the type and number of the immune cells in the microenvironment predicts how well immunotherapeutics work, their approach could potentially give doctors the information they need to personalize therapies. Burack and Mosmann, who have received a Wilmot seed grant to support their work, are also analyzing the microenvironment to understand more about what makes immunotherapies for lymphoma work. “We don’t know if the efficacy of immunotherapies is based on the immune composition of the tumor or if it’s based on the patient’s overall immune status,” Burack says. “If we understand the relationship between the patient’s global immune system and the occurrence or recurrence of their lymphoma, we may have another marker to follow in patients that will tell us when to start or reinitiate therapy.”

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Personalizing therapies

Paul Barr, M.D.

Jonathan Friedberg, M.D.

Carla Casulo, M.D.

At Wilmot, specialized pathologists are looking at ways to discern why some lymphomas that seem similar can behave so differently. They are studying lymphoma’s genetic fingerprints and other molecular features to understand their influence on treatment and prognosis. “It’s like looking at spots on a dog,” says hematopathologist Andrew Evans, M.D. “On the outside, a Dalmatian looks different than a cocker spaniel, but you need to understand inside what makes them different biologically.” Evans, Burack and their colleagues are approaching this from a number of angles. They are looking to identify molecular changes that could signal when a low-grade lymphoma will become more aggressive. They are examining lymphomas at different points in time and from different locations in the body to understand how the disease changes and interacts with their environment. “We need to understand lymphoma at a finer level,” Evans says. That understanding is driving a shift away from one-size-fitsall treatment, as investigators find new ways to undermine the cancer’s survival mechanisms. “The better we understand all of the different lymphomas, the more we recognize that the treatment approaches need to be personalized,” says Louis "Sandy" Constine, M.D., a Wilmot radiation oncologist who helps lead national and international committees dedicated to developing criteria and guidelines for using radiation therapy to treat lymphoma. “This is a dynamic field with new discoveries that open doors for new approaches to treatment.” One example is chronic lymphocytic leukemia, also called small lymphocytic lymphoma in some patients. CLL is the most prevalent form of blood cancer in the United States. Until a few years ago, it was a devastating disease for patients who didn’t respond to standard chemotherapy. Through participation in national clinical trials, Wilmot contributed to the development of three drugs that have revolutionized the treatment of CLL. These drugs — ibrutinib, idelalisib and venetoclax — work by interfering with the lymphoma cells’ ability to grow unchecked. They were given accelerated approval by the U.S. Food and Drug Administration over the last two years after nationwide clinical trials.

Advancing treatment

Clive Zent, M.D.

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Clinical trials are a priority for Wilmot’s lymphoma program, which enrolls about 25 percent of patients needing treatment on these studies. By participating in cooperative groups like SWOG and partnering with industry, Wilmot can stay at the forefront of lymphoma care and offer patients access to new treatments and technology. “We’re constantly thinking not just about how we are treating


patients today, but how we are going to treat them in 20 years and planning for the future,” Barr says. Wilmot’s portfolio of lymphoma trials includes new techniques for blood and marrow transplants, targeted therapies, and immunotherapies that attack the cancer cells in different ways. The availability of trials gives patients more options if they don’t respond to standard treatments or when their therapies stop working. “A quarter of our patients are getting treatments today that may not be widely available,” says Jonathan W. Friedberg, M.D., M.M.Sc., Wilmot’s director and a lymphoma expert who has led international efforts to design trials and educate other hematologists and oncologists about new findings. For example, Wilmot is one of the only cancer centers in New York state to offer CAR T-cell therapy trials for patients with lymphoma. This novel therapy involves re-engineering a patient’s immune cells and training them to attack the cancer. So far, two patients at Wilmot have participated in these trials, and they have gone into remission. The first patient at Wilmot to undergo CAR T-cell therapy, Ed Foster of Elmira, went into remission for nine months, allowing him to return to his work as a physician and to enjoy hunting and fishing. Although his cancer returned and he later died, his experience in the trial continues to inform the researchers at Wilmot and nationwide who are also part of this study. “We were able to take a biopsy of his tumor and were able to study it to find out how it escaped the CAR T-cell therapy,” Friedberg says. “We think we understand why it progressed and this will inform future research efforts to prevent these recurrent events.” Even after trials close and therapies are approved by the FDA, clinical investigators continue to follow patients who are on those drugs. For example, Wilmot’s team maintains a database that includes information on 500 CLL patients they’ve managed since 2014. This data allows them to see how patients are doing in the real world — not just in the defined conditions of a clinical trial. They are looking at how well patients are tolerating medications like ibrutinib and idelalisib, which patients have had to stop taking them and why, and what happens to those patients after they discontinue those drugs. They’re investigating the impact of the shift from chemotherapy to targeted agents on patients’ risk for infections or secondary cancers and on the risk of cognitive problems like chemo-brain. “This database allows us to look at the big picture,” Barr says. “Are we improving not just one treatment but also patients’ lives as a whole? That’s something that you can’t study in a clinical trial.”

Seeking answers in an immune cell’s appetite Monoclonal antibodies are a form of immunotherapy that have revolutionized the treatment of nonHodgkin lymphoma. However, patients can develop resistance to these therapies, and the reasons are not well understood. These drugs, such as rituximab, are proteins designed to bind to lymphoma cells and serve as targets for immune cells called macrophages, which engulf and digest the cancer cells. Wilmot hematologist Clive Zent, M.D., suspects that one reason monoclonal antibodies become less effective is that the macrophages get full. Working with scientist Charles Chu, Ph.D., and immunologist Michael “Rusty” Elliott, Ph.D., Zent and his team have found that when the macrophages consume a large number of lymphoma cells, they stop eating. Or, they just nibble the targets off the lymphoma cells, leaving the cancer unrecognizable to the immune system. After about 24 hours, though, the full macrophages are ready to eat again. “We know how macrophages recognize and eat these cancer cells,” Elliott explains. “But we don’t understand how they know how much to eat.” He and Zent are studying this mechanism to find strategies to keep the macrophages from getting full and to keep the monoclonal antibodies working as they should. “We need to figure out how to keep the system chugging along,” Zent says.

A macrophage from mouse bone marrow engulfs lymphoma cells that have been coated with monoclonal antibodies and labeled with a purple dye.

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Targeting treatment for special populations While Wilmot participates in many national studies, the lymphoma team is also developing its own trials. Patrick Reagan, M.D., for example, is working with Wilmot’s Geriatric Oncology team to study a modified version of the standard treatment for diffuse large B-cell lymphoma (DLBCL) in older adults. While many DLBCL patients are cured using the standard treatment — a chemotherapy regimen known as R-CHOP — a subset will not respond at all. “We’re trying to develop a targeted approach in a group, where if the disease comes back, we have few effective treatment options,” Reagan says. The goal of Reagan’s study is to improve older adults’ response to chemotherapy without adding to the side effects. His trial will incorporate the drug brentuximab vedotin, which targets a protein called CD30 that is present in about a quarter of large-cell lymphomas, into the standard therapy. As part of the study, he will also be evaluating the impact on activities of daily living, as well as any changes in cognition, among other factors. In addition, his team is looking at the changes in the immune system that occur with age and the influence it has on B and T cells, which are involved in lymphoma. “This is a great area for research because this is a common disease and there is a lot of room for improvement,” Reagan says.

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Good teams and good science As with CLL, Wilmot has helped establish an international database to follow cases of hairy cell leukemia, a rare and slow-growing lymphoid malignancy that can be serious if left untreated. As one of 23 institutions worldwide to become a Center of Excellence for Hairy Cell Leukemia, Wilmot also helped develop management guidelines for this disease that were published earlier this year. Collaborations such as this are among the strengths of Wilmot’s lymphoma program. Their reputation for working together has brought them many invitations to participate in important national and international projects. Another example is the Lymphoma Epidemiology of Outcomes (LEO) Cohort Study, which will follow 12,000 patients over five years to learn more about the possible causes, best treatments and survivorship in non-Hodgkin lymphoma. Seven other prominent medical centers, including Mayo Clinic, MD Anderson and Washington University of St. Louis, are also participating in this project. At Wilmot, about four patients per week agree to be followed as part of this observational study, which includes genetic analysis of their cancers, clinical outcomes and information that patients report about their health. It will help researchers better understand how lymphomas develop, what factors lead to their progression and how these diverse diseases respond to a variety of treatments and other conditions. “With this consortium, we are poised to make major contributions to the understanding and treatment of lymphoma,” says Friedberg, one of the principal investigators on the LEO project. Casulo and Burack are also investigators. Although the LEO Cohort Study is observational, it also provides an infrastructure for the participating centers to work together on therapeutic trials — studies that test new treatments or regimens. Friedberg, for example, is planning a large randomized clinical trial that includes the LEO centers to evaluate whether adding vitamin D to standard treatment for follicular lymphoma will improve outcomes. Funded with over $3 million by the National Cancer Institute, this study could provide a relatively simple, inexpensive way to improve overall survival among these patients. “This could have incredibly broad impact,” Friedberg says. “If the trial is positive, this could become part of standard practice worldwide.” For the patients at Wilmot, access to clinical trials means that impact can come sooner and that more options are on the horizon. For Steve Corey, a trial testing the combination of ibrutinib with the standard treatment for his lymphoma — a chemotherapy regimen known as R-CHOP — brought remission for nine months. It also brought time for another drug to become available and keep his cancer at bay. Even though his cancer came back, he’s confident in his team’s expertise and interest in new therapies. “I’ve been blessed with good teams and good science,” Corey says. “Every day is another day you may get a break.”


Exercise and Cancer Research: Setting New Standards, Giving Patients Control By Leslie Orr

When someone would ask Harriette Royer if she was interested in joining a gym, her answer was usually the same: “Oh no, that’s not for me.” Then cancer showed up and her thoughts changed. Royer volunteered for a Wilmot Cancer Institute study testing the value of strength training and walking during breast cancer treatment. Exercise contributed to her healing, she says, and now she’s a true believer. In the five years since her diagnosis, Royer has been taking Pilates and yoga classes and walking to work. She’s an assistant director of career services for the Warner School of Education at the University of Rochester and her daily jaunt, no matter what the weather, takes her about a mile from the city’s 19th Ward to her UR office. She even purchased a pair of those funky FiveFinger shoes by Vibram. “I’m that person who parks the farthest away. I take the stairs and I take walks in and around my building to increase my mileage. I just keep moving,” Royer says. “It’s very important for me to keep my spirits up and stay healthy.”

Since her cancer diagnosis five years ago, Harriette Royer embraces regular exercise.

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Cancer survivor John Perkins works in the PEAK Lab with exercise physiologist Michelle Porto.

Not only is Royer on the right path but she’s in the right place— Rochester is a leader in the field of exercise oncology. The program at Wilmot was founded by Karen Mustian, Ph.D., M.P.H., an industry pioneer who has since mentored a cadre of junior scientists who are also studying the benefits of physical activity when cancer strikes. Science is proving that exercise is an inexpensive, non-toxic way to alleviate the crushing fatigue that often accompanies cancer and its treatment, or to reduce sleep disturbances, brain fogginess, neuropathy in the limbs, or anxiety, for example. “People tend to naturally think of taking a nap, or getting extra cups of coffee, or a pharmaceutical solution,

if they’re feeling extra fatigue,” says Mustian, an associate professor in the URMC Department of Surgery and a Wilmot investigator since 2003. “It’s very hard for cancer patients and the medical community to wrap their heads around exercise because this intervention has not been frontand-center in the past. Nearly 15 years ago when we started this work, a lot of people believed it wasn’t safe for most cancer patients to exercise,” Mustian recalls. “Now we know it can be safe when done correctly, and that it has measurable benefits.”

Building a powerhouse The good news is that cancer patients need not run a 5K, play vigorous

sports, or take part in strenuous classes to benefit. Gentle walking, gentle yoga poses or stretching, and using elastic resistance bands at home, for example, are enough to help a person maintain strength and physical activity throughout chemotherapy or other treatments. The hardest part is convincing people who do not exercise to buy into it, Mustian says, particularly when a newly diagnosed cancer patient is tired and overwhelmed with information. (Approximately 80 percent of the people who’ve enrolled in Wilmot’s exercise studies are sedentary.) The field of cardiology was in the same position as cancer many years ago, but today exercise is usually expected and prescribed as part of rehabilitation after a heart attack. As the cancer community marches toward similar goals, Mustian and colleagues are influencing the changes. Wilmot’s Exercise and Oncology Research Program is regularly featured at national meetings, and a recent study from Mustian's group was published in the high-impact journal, JAMA Oncology, and featured on NBC Nightly News with Lester Holt. Because of its unique structure, the team also has the capability to work with cancer clinics across the country, enrolling hundreds of patients in large, randomized studies to test innovative new approaches to care.

-Karen Mustian, Ph.D., M.P.H.

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The exercise researchers are part of the WCI Cancer Control and Survivorship Research Program, co-directed by Mustian and Gary Morrow, Ph.D. Primary scientists include Calvin Cole, Ph.D.; Richard Dunne, M.D.; Fergal Fleming, M.D.; Chunkit Fung, M.D.; Michelle Janeslins, Ph.D.; Charles Kamen, Ph.D.; Ian Kleckner, Ph.D.; Po Ju Lin, Ph.D.; Melissa Loh, MBBch; Supriya Mohile, M.D.; and Luke Peppone, Ph.D. “Our program at the University of Rochester is becoming a real powerhouse in exercise oncology, nationally and internationally,” says Mustian, noting that exercise as a way to control cancer’s side effects is also a research priority for the National Cancer Institute.

Results of several large Wilmot studies include: Exercise and/or behavioral-change therapy works better than medications to reduce cancer-related fatigue, the most common side effect during and after cancer treatment. Simple, low-cost exercise such as walking reduces chronic inflammation and protects against cognitive decline, known among patients as “chemo-brain.” Exercise reduces neuropathy (shooting pains, tingling, numbness, sensitivity to cold) in hands and feet, particularly in older cancer patients. Yoga benefits cancer patients by improving fatigue, anxiety, stress, depression, insomnia, memory loss, musculoskeletal pain, and overall quality of life. Only four weeks of walking and resistance-band strength training during radiation therapy results in better fitness and less fatigue. Tai chi is effective for improving self-esteem, physical function and quality of life in breast cancer survivors.

Amy Schnitzler was a runner before her breast cancer diagnosis in 2016. She has continued to exercise regularly throughout her treatment.

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Joe Mercik does push-ups with his children Luke and Harleigh.

Two specialized, copyrighted exercise programs developed by Mustian form the bedrock of many of Wilmot's clinical studies: EXCAP (Exercise for Cancer Patients) and YOCAS (Yoga for Cancer Survivors). They were designed for any age and can be adapted to nearly any situation. In addition, research participants are evaluated at URMC’s PEAK Human Performance Lab, also founded by Mustian. The Lab measures a patient’s metabolism, heart and lung function, range of motion, strength, balance, functional capabilities and other outcomes such as inflammation and gene expression before, during, and after treatment. “The fact that we can take a person who’s never really exercised and get them moving during cancer treatment is really remarkable,” Mustian says.

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Teachable moments Despite the strides made, however, a lot of questions are still unanswered. Should exercise be doled out in personalized doses, like medications? Is more necessarily better? What biological pathways are impacted by exercise in a cancer patient? And, what about timing? Wilmot surgeon Fergal Fleming, M.D., observed something that sparked his interest in the timing question. Fleming corrects bowel disorders, including colon and rectal cancer and non-cancerous conditions such as Crohn’s disease. In a pilot study, he tracked a small number of patients who were minimally active before surgery, taking about 4,000 steps a day, and discovered that their activity level plunged to 1,800 steps a day after surgery, with no improvement over the next for weeks. (Healthy people need to

walk about 5,000 steps daily to be considered low-active, 7,500 steps to be somewhat active, 10,000 steps to be active and 12,500 steps to be highly active.) Fleming says that three months after surgery, 30 percent to 40 percent of adults still aren’t back to their pre-operative fitness level. This concerns him and he wondered: If a patient starts an exercise program in the days and weeks leading up to surgery, can you reduce the fitness plunge and improve outcomes? He designed a formal study, which will be enrolling patients for the next year, to assess the impact of exercise on patients undergoing colon and/or rectal cancer surgery. Most of his patients receive chemotherapy or radiation before surgery, and then recover for about eight weeks prior to their


-Fergal Fleming, M.D.

operation. During that eight-week rest period, the study participants are offered a version of the EXCAP program that includes in-home strength training and walking. So far, Fleming says, the patients who’ve signed up are enthusiastic. They range in age from the 30s to 80s. His objective is to find out if individuals who exercise during the rest period have better surgical recoveries and are in better shape—both physically and psychologically—to cope with a second round of chemotherapy after surgery. “People are overwhelmed with information when they learn they have cancer and talking about exercise can seem like just one more thing,” Fleming says. “But ironically, people are also more open to lifestyle changes at the time of diagnosis. They want to know what they can do to improve their outcome and they want a sense of control. I look at this as a teachable moment.” Fleming also believes that for many people, such as Royer, exposure to exercise while sick will have a lasting effect.

A perfect gift Some cancer patients don’t need to be sold on exercise because they've always done it. Joe Mercik, 42, an Irondequoit resident and former professional soccer player for the Rochester Rhinos, did strength training,

sit-ups and push-ups at home throughout his chemotherapy treatment for testicular cancer in 2010. Exercise has defined him since he was a youngster, he says, and it still gives him energy, focus, confidence, and motivation.These days, he sometimes exercises with his two small children, Luke, 3, and Harleigh, 1, in tow. “Staying positive through the diagnosis, treatments, and post therapy is vital to beating this terrible disease,” Mercik says. “Exercise and physical fitness is a close second. It helped me prepare for what was ahead, and gave me strength and courage.” The same is true for another young patient, Amy Schnitzler, 27, of Henrietta, who recently completed several rounds of chemotherapy for metastatic breast cancer. She was a frequent five-mile-a-day outdoor runner before she was diagnosed with cancer in 2016, and Schnitzler’s family chipped in and bought her a treadmill to use indoors when she wasn’t feeling well enough to go outside. “It was so awesome,” she says. “A lot of times people don’t know what to do or say when someone they love has cancer, but this was the perfect gift.” During treatment she walked or jogged slowly on the treadmill, and on her worst days she did simple stretches to keep the blood flowing. As she regains strength, she has her eye on kick-boxing class. “I exercise to feel like myself,” Schnitzler says.

“One of the biggest things I felt after the cancer diagnosis was a huge lack of control. And my recurrence was dismantling. I needed to be able to say: ‘I can control the food I put into my body and I can keep moving. I can participate in my own health.’“

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Kathy Reichwald gets together with neighbors every week to play cards.

New Clinic Supports Patients with Inherited Cancer Syndromes By Lydia Fernandez

When Kathy Reichwald was diagnosed with colon cancer in 2015, all signs pointed to Lynch syndrome, an inherited condition that increases a person’s risk for gastrointestinal, gynecologic and other cancers.

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A routine colonoscopy found a tumor that had the typical characteristics of a Lynch-related colorectal cancer. Even her pathology indicated that the tumor was likely the result of Lynch syndrome, which is associated with about 3 percent to 5 percent of new colorectal cancers. After her surgery, when the results of her genetic test came back, she learned that all of the genes known to be associated with this hereditary cancer syndrome were normal. “Everything pointed to Lynch, but it was not Lynch,” Reichwald says. Instead of being relieved, Reichwald, 69, of Greece, became anxious. Her test results left open the possibility that she has Lynch syndrome but that the science hasn’t yet identified all of the gene changes associated with it. She was afraid that she wouldn’t be able to get the screenings she needed, and she didn’t know what to tell her children or her siblings. Her medical oncologist, Marcus Noel, M.D., referred her to Wilmot’s Hereditary Cancer Screening and Risk Reduction Clinic for support.

The clinic is designed to guide and support individuals and families who have inherited cancer syndromes or a strong family history of cancer. Run by medical oncologist Michelle Shayne, M.D., and senior nurse practitioner Carol Lustig, RN MSN ANP-BC, the clinic helps patients navigate a new schedule of cancer screenings and offers guidance on how to talk to their family members about their risk. The clinic, which debuted late last year, picks up where genetic testing leaves off, offering individuals and families regular, long-term follow-up. “I was thrilled,” says Reichwald. “I didn’t want to fall through the cracks.” Hereditary cancer syndromes are caused by mutations in genes that are passed from parents to children. These gene changes put families at higher risk for certain cancers, and they play a major role in about 5 percent to 10 percent of all cancers. Scientists have associated mutations in specific genes with more than 50 hereditary cancer syndromes. Among the most well-known examples are the BRCA1 and BRCA2 genes, which are associated with hereditary


Carol Lustig, RN MSN ANP-BC

Michelle Shayne, M.D.

breast and ovarian cancer syndrome. Other examples include Li-Fraumeni syndrome, which increases the risk for bone and soft tissue cancers, breast cancer, brain tumors, and cancer of the adrenal gland; and Cowden syndrome, which increases the risk of breast, thyroid, endometrial, and other types of cancer. Having an inherited mutation isn’t a guarantee that a person will develop cancer, but physicians recommend that they begin screening at younger ages and do it more frequently than the rest of the population. “With this program, we have the opportunity to detect cancer early and to prevent cancers,” says Lustig, who specializes in gastrointestinal cancers and has a special interest in hereditary cancer syndromes. Patients are referred to the clinic by geneticists, primary care providers who know their patients have hereditary cancer syndromes, medical oncologists and others who suspect the patient’s cancer may be linked to inherited gene changes. “Patients who come to this clinic report a great sense of relief at not having to manage the complexities of surveillance on

their own,” says Shayne, who specializes in breast cancers. “We’re helping patients weigh their options and decide what makes sense for them.” For Sue Robinson, 68, of Honeoye Falls, taking a more natural approach has helped. Diagnosed with colon cancer at age 37, she didn’t learn that she had Lynch syndrome until about 15 years ago when she participated in a study that tested for gene changes. She could have opted to have a hysterectomy or to have her colon removed to reduce her risk for developing another cancer. “With Lynch syndrome, I could take every part of my body and have nothing left,” says Robinson, who visited Wilmot’s hereditary cancers clinic on the recommendation of her gastroenterologist, Danielle Marino, M.D. Instead, she follows the recommendations for screening and focuses on eating whole foods and a plant-based diet. Over the years, she has made sure that her son and daughter, now grown, understand their risk and their options. She keeps herself and her family educated, and she encourages others not to fear information. “I keep telling everybody that

knowledge is power,” says Robinson, who lost her brother to a Lynch-related brain cancer and has a sister without Lynch syndrome. With rapid advances in the understanding of genetics and cancer, that knowledge will be powerful for patients and oncologists. New information can provide clues as to next steps — and some peace of mind — for patients like Reichwald. “I feel safer because if they find a gene for me, they’ll notify me,” Reichwald says. In the meantime, she knows when to get screened and for what, and she has a plan for diet and exercise. “I have a team behind me.”

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Community Focus Community events are vital to Wilmot’s success and the ability to help patients and further research. To learn more about third-party events or to host your own, please contact Tiffany Paine-Cirrincione at tiffany.paine@rochester.edu or (585) 276-4715. In the 2016-2017 fiscal year, 39 community organizations raised $359,000. These funds support research and the patient needs fund at Wilmot Cancer Institute. The following community groups and events contributed to those funds: 4 Performance – American Junior Golf Classic Adding Candles for a Cure Barbara Occhipinti Memorial Fundraiser Blue September Blow the Whistle on Cancer Brighton High School Field Hockey’s Play for a Cure Event Byron Bergen Girls Soccer Team Coop Cup Cornell’s Jewelers Watch Program Cupcakes for Cancer Edelman Gardner Cancer Research Foundation Fairport Football Booster Club Flaherty’s Golf Tournament For Pete’s Sake Golf Tournament Golden Soccer Challenge Go Pink! Towpath Community Foundation Highlands at Pittsford Fashion Show Hope Floats Kayak Challenge Keeping the Hope Alive KM Memorial Golf Tournament Kovalsky Carr Electric Supply Michael Contestabile Memorial Golf Tournament Mo Open Golf Tournament Nazareth Women’s Soccer Team Oswego Men’s Lacrosse Team Order of the Sons of Italy NYS Lodge Foundation Palmer/Head-Strong Golf Tournament Pancreatic Cancer Association of WNY Penfield High School Boys Soccer Team Ray Dutcher Memorial Golf Tournament Retired Professional Firefighters Against Cancer Rochester Academy Charter School Rochester Melanoma Action Group Sackett Jeffords Memorial Golf Tournament Stand Against Cancer Steve’s 5K to Run Down Cancer Steve Coleman Memorial Golf Tournament Strollin for the Colon Us TOO Rochester During the last year, Wilmot has benefitted from:

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DISCOVERY BALL

FOCUSES ON PROMISE OF IMMUNOTHERAPY

Ron Wood and his daughter Kaleigh accept the Inspiration Award during the Discovery Ball.

The 18th annual Wilmot Cancer Institute Discovery Ball raised nearly $690,000 to support research on immunotherapy. Immunotherapy boosts, restores or improves the body’s own natural defenses against cancer, and Wilmot is developing new approaches while also offering some of the nation’s most important clinical trials, ensuring that patients have access to the latest immunotherapies. The event honored Ron Wood of Shortsville and his daughter Kaleigh with the Inspiration Award. Wood underwent a haploidentical stem cell transplant at Wilmot in 2016 to treat his rare form of leukemia, and Kaleigh was his donor. Because a matching donor could not be found in the international donor registries, Wood became eligible for a clinical trial at Wilmot testing transplants with donors who are 50 percent matches. “Without her bone marrow donation and steadfast care during and after the transplant, I would not be standing here,” Ron said after receiving the award.

Discovery Ball co-chairs Janice Linehan and Kathy Landers enjoy the evening with their husbands David Linehan, M.D., left, and Peter Landers.

"The Discovery Ball was a spectacular and moving celebration full of energy." “One of the most valuable things I've learned this year has been that if you're in a position to help someone else or lift them up — however that might be — you should,” Kaleigh said. “You never know when you might need that help reciprocated.” Wilmot board member Kathy Landers co-chaired the Discovery Ball with Janice Linehan, wife of Wilmot’s co-director David Linehan, M.D. Landers and Linehan share a special bond as both survived Hodgkin lymphoma as young adults and breast cancer years later. “The Discovery Ball was a spectacular and moving celebration, full of energy, and we were honored to serve as co-chairs,” Landers said. “It is through the passion of those who attended that we will make a difference in the future of cancer care and prevention,” Linehan said.

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THANK YOU

TO OUR 2017 DISCOVERY BALL SPONSORS INSIGHT SPONSOR • Mr. & Mrs. Richard & Marianne Bell • Indivumed Inc. MOMENT SPONSOR • Centene Charitable Foundation • Mr. & Mrs. Jay & Sandra Gelb and Wolk family • Mr. & Mrs. Frank & Cricket Luellen • Taylor, The Builders • Mr. & Mrs. Thomas & Colleen Wilmot CONNECTION SPONSOR • Bristol-Meyers Squibb • Constellation Brands • Commodity Resource Corporation • Hahn Automotive • Harris Beach, PLLC • Mr. & Mrs. James & Donna Hammer • Interlakes Oncology and Hematology, P.C. • KeyBank • Mr. & Mrs. Peter & Kathy Landers • Dr. & Mrs. David & Janice Linehan • Mr. & Mrs. Paul & Judy Linehan • Pluta Cancer Center Foundation • Dr. Larissa Temple & Mr. Alan Winchester • URMC Department of Pathology & Laboratory Medicine • Wegmans Food Markets Inc. • Mr. & Mrs. Daniel and Meredith Wilmot • Mr. & Mrs. Dennis & Katie Wilmot • Ms. Mary Wilmot, Mr. James Worboys & Mrs. Kailey Mulvihill • Dr. Patrick Wilmot • Ms. Sallie Wilmot & Mr. David Avery • Wisteria Flowers & Gifts

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COLLABORATION SPONSOR • Advantage Federal Credit Union • BME Associates • Bond Financial Network • Mr. & Mrs. Joseph & Elaine Bucci • Celgene • Dr. Yuhchyau Chen & URMC Radiation Oncology Faculty • Cobblestone Capital Advisors, LLC • del Lago Resort & Casino • DGA Builders • Dixon Schwabl • Dr. & Mrs. David & Beth Ann Dougherty • Excellus BlueCross BlueShield • Drs. Jonathan Friedberg & Laura Calvi • Harter Secrest & Emery • Highland Hospital Administration • James P. Wilmot Foundation • Mr. Mark Kokanovich & Mrs. Jean Maess • Dr. Hucky Land & Mrs. Colleen Buzzard • Drs. Jane Liesveld & Deepak Sahasrabudhe • Dr. & Mrs. Shawn & Paula Newlands • Nixon Peabody LLP • Nothnagle Realtors- Patrice K. Bircher • Paychex • The Pike Company, Inc. • PricewaterhouseCoopers, LLP • Drs. Timothy O'Connor & Avice O'Connell • Roswell Park Cancer Institute • Seattle Genetics • Mrs. Stacey Spoto • The Storage Mall • Strong Memorial Hospital Leadership • URMC Department of Gastroenterology & Hepatology • URMC Department of Gynecologic Oncology • URMC Department of Hematology & Oncology

• URMC Department of Neurosurgery • URMC Department of Orthopaedics and Rehabilitation • URMC Department of Surgery/ Division of Cancer Control • URMC Department of Surgical Oncology • URMC Divison of HPB-GI Surgery • URMC Division of Thoracic & Foregut Surgery • UR Medicine Marketing • Ward, Greenberg, Heller & Reidy, LLP • Mr. & Mrs. James & Shannon Wilmot • Woods Oviatt Gilman • Mrs. Marion Wilmot • Mr. & Mrs. Richard & Caroline Yates OPPORTUNITY SPONSOR • Dr. & Mrs. Michael & Diane Becker • Bergmann Associates • Bonadio & Co., LLP • Mr. Michael Buckley • Mr. & Mrs. Spencer & Elizabeth Cook • Eli Lilly and Company • Mr. & Mrs. Charles & Marcia Fallon • Fischer Group at Graystone Consulting - Rochester • Mr. & Mrs. David & Elisabeth Gaudino • The Goodbody Group • Mr. & Mrs. Brian and Julie Martin • More Than a Game Foundation • M&T Bank • Northwest Bank • Premium Mortgage Corporation • Mr. & Mrs. Donald & Pamela Rhoda • Ms. Leigh Williams


CALENDAR OF COMMUNIT Y EVENTS July 28 Batavia Survivors Night at Dwyer Stadium Join Wilmot Cancer Institute for an evening of baseball and celebrating cancer survivorship at Survivors Night at Dwyer Stadium with the Batavia Muckdogs. To learn more, visit wilmot. urmc.edu/events.

Aug. 19 Hope Floats Kayak Challenge Organizers will attempt to break a world record while raising money for Wilmot Cancer Institute. This event takes place at Lakefront Park in Geneva. To learn more or register, visit seneca5ck.com.

Sept. 14 Third Annual Adding Candles for a Cure This fundraiser supports brain cancer research at Wilmot. Taking place at Oak Hill Country Club from 6 to 9:30 p.m., it features hors d’oeuvres, raffles and more. Details are available at www. addingcandles.com.

Aug. 11 Survivors Night at the Ballpark Back for its fifth year, this event brings together cancer survivors and their friends and families to celebrate cancer survivorship during a Rochester Red Wings game. To learn more, visit wilmot. urmc.edu/events.

Aug. 19 SEA Blue Ribbon Walk by Us TOO Rochester A portion of proceeds from this event will benefit a potential prostate cancer survivorship program at Wilmot. Learn more at seablue.rochester.org.

Oct. 8 Go Pink! Towpath Community Foundation Breast Cancer Bike Event This fundraiser features a 5K run as well as a 10-mile, 25-mile and 50-mile bike ride. It takes place at Mendon Ponds Park from 9 a.m. to noon, and proceeds support breast cancer research at Wilmot. Learn more at wilmot.urmc.edu/events.

Aug. 13 Eleventh Annual Keeping the Hope Alive This event features raffles and fun at Flaherty’s Three Flags Inn in Macedon from 1 to 5 p.m. Proceeds benefit breast cancer research at Wilmot. To learn more, contact Paula Bokman at BokmanM@aol.com. Aug. 14 Third Annual Palmer/Head-Strong Golf Tournament This tournament starts at 11 a.m. at Greystone Golf Club in Walworth. Proceeds will be split between research for non-smokers lung cancer and research for pancreatic cancer. To learn more, contact Keith Greer at keith.greer59@gmail.com.

Sept. 10 Wilmot Warrior Walk The Warrior Walk is a Wilmot premier community event. It takes place at the Highland Park Bowl and features a certified 5K, 10K and 1-mile walk, plus tons of fun at the post-race celebration. Proceeds support Wilmot’s Judy DiMarzo Cancer Survivorship Program as well as cancer research. Learn more or register at WarriorWalk.URMC.edu. Sept. 11 Fourth Annual Ray Dutcher Jr. Memorial Golf Tournament This golf tournament supports brain cancer research at Wilmot. It takes place at Webster Golf Course. To learn more, visit www.facebook.com/ RDJrGolfTournament.

Nov. 18 Eighth Annual Step It Up! Cure Pancreatic Cancer Walk The Pancreatic Cancer Association of Western New York hosts this event to support pancreatic cancer research at Wilmot. The event features a 5K and takes place at the RIT Gordon Field House from noon to 4 p.m. Learn more at pcawny.org/ Step_It_Up_5K.html.

Survivors Night at the Ballpark Celebrate life beyond cancer during one of Wilmot Cancer Institute’s Survivors Nights. All cancer patients, survivors and caregivers are invited to attend at a reduced rate. Games start at 7:05 p.m. July 28 at Dwyer Stadium in Batavia Aug. 11 at Frontier Field in Rochester Details, including ticket purchase information, will be available at Wilmot.URMC.edu/events.

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Wilmot Cancer Institute 601 Elmwood Avenue, Box 704 Rochester, NY 14642

Wilmot Warrior Walk September 10, 2017 Highland Park Bowl

Join us in celebrating all cancer survivors, remembering those we've lost, and supporting local cancer research. The event features a 5K, 10K or 1-mile walk and post-race celebration. Funds support cancer research and Wilmot’s Judy DiMarzo Cancer Survivorship Program. Learn more or register at

WarriorWalk.URMC.edu

/wilmotcancerinstitute

@wilmotcancer

Non-Profit Org. U.S. Postage PAID Permit No. 780 Rochester, NY