Dialogue 2019 Volume 1

2019 Volume I

Wilmot Cancer Institute | University of Rochester Medical Center

Shaping the Future Training the next generation of doctors, scientists p. 6

LETTER FROM THE DIRECTOR Hello Friends of Wilmot Cancer Institute,

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

At Wilmot, we have four key missions — patient care, research, community engagement and education. In this issue of Dialogue, we focus on education.

Wilmot is an integral part of the University of Rochester Medical Center, which is consistently ranked among the top medical schools in the country, with highly competitive programs for medical and graduate education, residencies and fellowships. At Wilmot, we foster a collegial learning environment that emphasizes teamwork and coordination, as well as communication and appreciating the patient’s views and goals. We have mechanisms for teaching across the board, not only for our students, but also for faculty and staff as they progress in their careers.

We have several unique educational programs, now overseen by our Associate Director for Mentorship and Career Development Edith Lord, Ph.D., and our Assistant Director for Mentorship and Career Development Carla Casulo, M.D. For example, our training program in cancer supportive care research is one of only a very few programs in the country, and it has trained a generation of scientists making contributions with direct impact on patient care. Gary Morrow, Ph.D., M.S., and Michelle Janelsins, Ph.D., MPH, received an outstanding score on their recent renewal application for this program.

In addition, the Wilmot Cancer Research Fellowship has provided physicians the opportunity to broaden their research skills over the past 30 years. Funded by an endowment from the James P. Wilmot Foundation, these fellowships have trained scores of investigators. One of the earliest Wilmot fellows was immunologist William Bonnez, M.D., who made the discoveries that led to the development of the human papilloma virus (HPV) vaccine, one of the only vaccines in the world to prevent cancer. And, looking forward, Lord and chair of Surgery David Linehan, M.D., are creating a training program for the next generation of investigators linking basic scientists with surgeons to foster teamwork and collaboration.

As you’ll see in this issue, our trainees come from all over the country, from various backgrounds and with diverse goals. They make Wilmot a vibrant place, and their questions, their ideas and their energy push us to be better doctors, researchers and teachers, and that directly translates into better care for our patients.

The educational milieu is another reason I feel fortunate to work here at Wilmot. We are grateful to you for supporting all of our Wilmot missions.

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

On the Cover

Edith Lord, Ph.D., and Carla Casulo, M.D., lead Wilmot’s Mentorship and Career Development program.

Photo by Matt Wittmeyer The Wilmot Cancer Institute is a component of Strong Memorial Hospital.

Wilmot Cancer Institute National Advisory Board Members 2019 Dennis Wilmot, Chair Richard Bell Elaine Bucci Rina Chessin Michael Crumb Patrick Cunningham Kathleen Landers Michael Linehan Alyssa Lozipone Jett Mehta Carol Mullin Ralph Olney Doug Parker Walter Parkes Mary Pluta Ronald Pluta

Barbara Pluta-Randall Cheryl Pohlman Donald Rhoda Steve Whitman Paul Wilmot Richard Yates Keith Yeates John Zicari Faculty Members Yuhchyau Chen, M.D., Ph.D. Louis “Sandy” Constine, M.D. Aram F. Hezel, M.D. Gary Morrow, Ph.D., M.S. Christian Peyre, M.D. Emeritus Members Judy Linehan Jim Ryan, Jr.

Ex-Officio Members Kellie Anderson Jonathan W.Friedberg, M.D., M.M.Sc. Hucky Land, Ph.D. David C. Linehan, M.D. Mark Taubman, M.D. Honorary Board Members George Abraham, M.D. Michael Buckley Elaine Del Monte Richard DiMarzo Michael Donnelly Joan Feinbloom Janet Felosky James Hammer Paul Hanrahan Gary Haseley Sandra Hawks Lloyd Robert Kessler

Mark Kokanovich Frank & Cricket Luellen Ronald Maggio Steve McCluski Michael Norris Jeffrey Pierce Larry Rabinowitz Gregory Smith Philip Wehrheim Timothy W. Williams Timothy P. Wilmot Colleen Wilmot Thomas Wilmot Bruce Zicari II

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

CONTENTS COVER STORY

Shaping the Future As part of an academic medical center, Wilmot Cancer Institute is devoted to preparing the next generation of physicians and scientists to navigate the fast-paced, constantly changing field of cancer care and research.

2019 Volume I

2 Living Well with Cancer Wilmot’s new Pluta Integrative Oncology & Wellness Center brings a new approach to cancer care that emphasizes connection, healing, and less invasive, evidence-based practices.

14 Defining Moments Meet Paula Vertino, Ph.D., western New York native, loyal Buffalo Bills fan and the Wilmot Distinguished Professor in Cancer Genomics.

18 Driving Advances against Bladder Cancer Bladder cancer is one of the trickiest cancers to manage, and Wilmot researchers are finding new insights into what drives the disease and possible new treatment pathways.

22

News Briefs

27

Community Events

PAGE 6 Wilmot Cancer Institute1

1

Living Well, with Cancer Integrative oncology addresses physical, mental and emotional aspects of living with cancer

By Lydia Fernandez

Melissa Sciortino was tired of being tired.

She was eight months pregnant in 2014 when she was diagnosed with thyroid cancer. A week after her daughter was born, she had surgery to remove that endocrine gland and nearly 70 lymph nodes from her neck. Without the hormones the thyroid produces, Sciortino, now 36, began to experience a new, ongoing fatigue, on top of new motherhood.

About a year later, she had another surgery to remove almost 100 lymph nodes from her collarbone, chest and armpit area, where the cancer had spread. Last year, she found out the microscopic malignant cells had moved into her lungs.

Despite all of this, Sciortino stays active with her daughter, who is now 5.

2

find us on Facebook, Twitter and Instagram

“For me, it was like, look, I know I’m never going to fully treat it. I’m always going to be tired,” she says. “But if I could figure out a way to wake up and not just feel mentally exhausted, I would participate in it all day long.”

Her search led her to the new Pluta Integrative Oncology & Wellness Center at Wilmot Cancer Institute. The center, which opened in October 2018, emphasizes overall well-being during and after cancer treatment. It addresses the physical, mental and emotional aspects of living with cancer, keeping a focus on mitigating or preventing the side effects of cancer and its treatment, not treating the cancer itself.

“The idea that you can go through cancer and still be well is important,” says Judy

Zeeman-Golden, LCSW, who coordinates the Integrative Oncology Center, located on the second floor of Wilmot’s Pluta Cancer Center in Henrietta.

It is central to the concept of integrative oncology, a relatively new approach in cancer care that emphasizes connection, healing and less invasive, evidence-based practices. It incorporates complementary, or integrative, therapies that have been shown to be effective such as nutrition, yoga, meditation and acupuncture that are used alongside — not in place of — conventional treatments.

The goals of integrative oncology are “to optimize health, quality of life, and clinical outcomes across the cancer care continuum and to empower people to prevent cancer

and become active participants before, during, and beyond cancer treatment,” according to the Society for Integrative Oncology.

Put simply, the field is aimed at helping people feel better, which has an important impact on their treatment.

By mitigating or preventing side effects, integrative oncology practices have been shown to help patients tolerate their therapies better. They have been shown to help manage some of the long-term health effects of treatment and help prevent cancer recurrence.

Most people undergoing cancer treatment experience side effects that can include fatigue, insomnia, anxiety, stress, pain and nausea that arise with treatment, and they have long sought relief for these issues that can range from irritating to debilitating. National studies have found that as many as 30 percent to 50 percent of cancer patients use acupuncture, yoga, massage and meditation to address their side effects.

As the number of cancer survivors nationwide continues to rise and as people live longer with and beyond cancer, complementary therapies and the field of integrative oncology continue to gain traction.

Cancer care providers now have evidence from years of clinical research that shows these approaches are safe and effective.

Research in these areas continues, and it is helping to shape the field.

“We’re adding science to modalities that have been around for a long time,” says Alissa Huston, M.D., a medical oncologist and co-director of the Integrative Oncology Center. “We’re seeing further growth as patients’ interest grows.”

While the Pluta Integrative Oncology & Wellness Center is one of the only programs of its kind in upstate New York, it joins a growing number of centers nationwide at places like MD Anderson Cancer Center, Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center.

“Having practitioners who are trained in this area helps advise patients about what’s appropriate and not appropriate for their specific needs,” Zeeman-Golden says.

Precision Medicine for the Whole Person The acceptance of integrative oncology also reflects a shift in care away from a model that has a physician focused on a tumor to one where a team is partnering with an individual and their caregivers to treat their cancer. It’s about encouraging optimal health and empowering individuals to participate actively in achieving that, whatever it means for them.

“You can still feel better than where you’ve been,” says Marilyn Ling, M.D., a radiation oncologist and co-director of the Integrative Oncology Center.

To achieve that, the center offers consultations with patients to determine their specific needs — a process that Ling likens to precision medicine for the whole person.

During these sessions, Ling, for example, will review the patient’s diagnosis and treatment plans, but also discuss concerns the patient has about side effects and any goals they may have.

She will then use these details to develop a personalized plan for each patient.

For Sciortino, that meant addressing her fatigue by focusing on nutrition,

Opposite page: Melissa Sciortino creates a paper mosaic butterfly during a Creative Expressions art class with Gilda’s Club Rochester at Wilmot’s Pluta Integrative Oncology & Wellness Center.

Wilmot Cancer Institute

3

The Pluta Integrative Oncology & Wellness Center includes a fitness area and treatment rooms for services such as massage.

physical activity, and connection.

Before coming to the Integrative Oncology Center, she had tried services in the community but struggled because they weren’t designed for her.

“I was trying to do fitness classes with healthy folks, and I would take away the mindset that I couldn’t keep up,” she says.

“A massage therapist I was going to would say, ‘I’m overcharging you because the amount of pressure I can put on you as a cancer patient is minimal, where someone else coming in for relief, I can do deep tissue and justify that price.’”

Sciortino met Zeeman-Golden at Wilmot’s Cooking for Wellness class, a hands-on, plant-based cooking class held in collaboration with Gilda’s Club Rochester and the Pluta Cancer Center Foundation.

After an integrative oncology consultation,

4

find us on Facebook, Twitter and Instagram

she joined Livestrong, an exercise program designed for cancer survivors offered in collaboration with the YMCA of Greater Rochester. She has since branched out to participate in the art classes led by Gilda’s Club and signed up for yoga. She’s also interested in more personalized training through the ReNew fitness program, developed by scientists in Wilmot’s Cancer Control & Supportive Care Research program.

Every service offered at the Integrative Oncology Center is provided by specially trained and certified practitioners who understand the needs of people with cancer.

Not only can they provide safe modifications to exercises or therapies such as massage, they can communicate with the individual’s treatment team through the electronic medical record.

“Everything we do, every modality we offer and every person we hire is vetted by our two doctors who are the medical directors of this program,” Zeeman-Golden says.

The Integrative Oncology team also works closely with the researchers in the Cancer Control & Supportive Care Research program who are national leaders in addressing the side effects of cancer treatment through

non-pharmacologic approaches like exercise and nutrition.

Since she began coming to the Integrative Oncology Center, Sciortino says she can feel the difference.

“I feel good, I feel better,” Sciortino says.

“I do have bad days, but when I go to these programs, I’m excited. It gives me purpose.

I’m doing something, and I’m going to see my friends.”

The center is also a place where cancer isn’t always front and center, she says.

“Doing these programs, you are free to talk about your disease, your journey, as you wish,” Sciortino says. “There are many programs where we really didn’t talk about anything related to cancer. It was life, it was having fun, making something, enjoying each other’s company. Whether it was an hour or 45 minutes, you were living in that moment and you forget that you have cancer.”

Meeting a Growing Need The Pluta Integrative Oncology & Wellness Center is open to all Wilmot Cancer Institute patients, and it brings together services like massage, yoga and qi gong that had been

offered through Wilmot before but in a decentralized fashion.

The center is a collaboration between Wilmot Cancer Institute and the Pluta Cancer Center Foundation, which helped secure $1.35 million to construct the facility.

It features two treatment rooms for massage and acupuncture, a meditation room, a fitness area, and a multipurpose space where different classes are held.

With generous donor gifts, the Foundation also covers the costs of the individual therapies and group programs at the center so that patients do not have to pay for these services, which typically are not covered by insurance. This funding helps remove a barrier for patients and survivors who are facing other significant costs and may be out of work for treatment.

“I don’t have to worry about financing wellness activities that will help me,” Sciortino says. “This resource works, and it’s one less financial cost that you have to worry about.”

Since opening, more than 2,000 patients have participated in the center’s programs, far exceeding projections for the center.

“Everyone comes for different reasons,” says Zeeman-Golden. “We have patients with a stage 4 diagnosis and have a ton of joint pain and bone pain and are looking for relief of those symptoms. We have people who are going through chemotherapy who have high anxiety, poor sleep, stress, and they’re coming for that.”

Anne Wells, 59, started with massage therapy at Pluta a few years ago. She had been diagnosed with metastatic breast cancer after bouts of abdominal pain and other issues that no one suspected were cancer. During what was supposed to have been a minimally invasive procedure, her surgeon found metastatic disease throughout her body. Her minor procedure became major surgery and a long, hard recovery.

“The beauty of the massage was to be touched in a therapeutic setting that felt

good and felt healing, but with no pain or discomfort associated,” Wells says. “It was a wonderful experience.”

Since the opening of the Integrative Oncology Center last fall, she has participated in Livestrong and is looking forward to joining ReNew for a more customized fitness program to help her build strength.

“I’ll be in treatment for as long as I’m alive, so it’s important to me while I’m in treatment to feel the best that I can and to do as much as I can and keep challenging and pushing myself,” she says.

The Integrative Oncology team is now looking to expand its offerings and how best to reach patients in the region who may not be able to reach the center.

Projects include gathering data on why patients are coming and on the effectiveness of integrative modalities in managing specific symptoms. The center is also developing a nurse ambassador program that will train nurses to provide bedside and chairside strategies such as hand or foot massage techniques and aromatherapy.

Meanwhile, the offerings at the Integrative Oncology Center continue to evolve with patient needs and participation.

“It’s the constellation of services that helps you feel well,” Wells says. “It helps you feel like there’s hope and it’s worth doing these positive things that support your treatment.”

What’s the difference?

Complementary therapies are used alongside standard medical treatments, such as chemotherapy, radiation or surgery.

Alternative therapies are used instead of standard medical treatments.

Integrative therapies weave non-mainstream techniques into conventional medicine to create a cohesive approach toward treating patients.

Wilmot Cancer Institute

5

Shaping the Future Wilmot equips the next generation of oncologists and scientists with skills to navigate and make change

By Lydia Fernandez

After earning her Ph.D. in 2018, Nikesha Gilmore left a tumor immunology laboratory that used frogs and tadpoles as animal models to become a Grasshopper.

She joined the Cancer Control Research Training Program at Wilmot Cancer Institute, where each trainee — like the young student in the 1970s TV classic Kung Fu — is affectionately given that moniker. Her goal is to improve the lives of people with cancer by addressing the acute and long-term side effects of treatment.

“I’d like to be more of a translational/clinical scientist, to take what I learned in basic science and merge it with the clinical world and find my own niche,” Gilmore says.

Her challenge is doing that in a fast-paced, constantly changing field where the stakes are high and the goals are ambitious.

As part of an academic medical center, Wilmot has a responsibility to develop the next generation of physicians and researchers and to help shape the ever-evolving landscape of science and medicine. With education and training as key components of its mission, Wilmot offers residencies in surgery and radiation oncology, fellowships in hematology/oncology and different types of surgery, as well as post-doctoral training in a wide variety of sciences. Every year, these programs bring dozens of new physicians and scientists to Rochester, and many of them choose to stay after they finish. Those who move to other parts of the country take with them lessons in teamwork, collaboration and leadership.

6

find us on Facebook, Twitter and Instagram

Nikesha Gilmore, Ph.D., right, works with mentor Michelle Janelsins, Ph.D., MPH, in Wilmot’s Cancer Control Research Training Program.

Wilmot Cancer Institute

7

Bridging the laboratory and clinic In the laboratory and the clinic, collaboration has become crucial, and Wilmot’s programs instill the importance of teamwork within and across disciplines.

For example, Lord, a tumor immunologist, is working with David Linehan, M.D., the chair of Surgery at UR Medicine, to develop a training program that would bring postdoctoral fellows into the clinical arena and surgical residents into the laboratory.

Radiation Oncology resident Sara Hardy, M.D., is studying cognitive changes associated “We’d like both sides to see how the with partial brain radiation with one of her mentors, Michael Milano, M.D., Ph.D. other side does things because that’s always been a true gap in our culture,” says Lord, who served as the Senior Associate Dean for Graduate Education and Postdoctoral Affairs Keeping pace with change higher,” says Edith Lord, Ph.D., Wilmot’s at the University of Rochester’s School of Associate Director for Mentorship & Career Medicine and Dentistry for a decade.

Development.

Wilmot’s programs address more than how This arrangement will help the young Becoming an independent investigator is to treat cancer or run an experiment in the an increasingly competitive endeavor as the scientists understand the challenges their lab. They emphasize meeting a patient’s cost of research — driven by technology — clinical counterparts face with patients and needs now and anticipating what they’ll the clinicians to get a better grasp of the has grown, while funding for science has face in the future. They encourage different not. And advances in information are coming possibilities in the lab. perspectives in pursuit of new knowledge The connections with Linehan’s team have faster than any one person can keep up. and practical applications that will change been invaluable, Lord says.

“We can’t know enough ourselves to do cancer care and prevention.

“They’ve provided us with a clinical the work as it’s done now,” Lord says. “You In an era of rapid advances, especially connection that we’ve never had before,” need teams.” in technology, these programs also aim to she says. “And it brings perspective on how nurture a thirst for knowledge and a drive things are done in the clinic and influences for problem-solving. how we do mouse experiments.”

“The challenges with medical education have been basically trying to keep up with the technology,” says Rabih Salloum, M.D., who leads the residency program in General Surgery. “It is a continuous race, but the idea is no longer to try to train the residents on all this. The idea is to try to have the residents acquire the skill set that will allow them to continue learning on their own when they graduate.”

For scientific trainees, the challenges are similar.

“Advances in technology make our lives easier, but they also mean the bar is set

8

find us on Facebook, Twitter and Instagram

Edith Lord, Ph.D., right, discusses plans for Wilmot’s Mentorship and Career Development Program with Carla Casulo, M.D.

Even after a team has findings from their study, collaboration is essential.

“Every study that you do, no matter how impressive the results, you need to validate those findings, you need to make sure that they’re generalizable, you need to make sure that they’re going to be applicable to the wide scope of patients you see,” says Carla Casulo, M.D., Wilmot’s assistant director for Mentorship & Career Development. “Unless you collaborate with others, there’s really no way to do that.”

These lessons in multidisciplinary teamwork often begin with the mentors that trainees find at Wilmot.

Radiation Oncology resident Sara Hardy, M.D., came to Wilmot after completing another residency in neurology at Johns Hopkins. She was drawn in part by the

department’s focus on survivorship and addressing the late and long-term effects of cancer treatment.

In addition to her clinical training, Hardy has protected time for research through a competitive American Board of Radiology Holman Pathway Award she developed with her mentors, which supports trainees with strong clinical skills and an interest in a research career. With this time, she is planning a clinical trial that will evaluate cognitive changes after partial brain radiation and how that relates to dosing and brain connectivity.

“I have mentors in three different departments, and they routinely meet with me in one room,” Hardy says.

Her team includes Radiation Oncology residency director Michael Milano, M.D.,

Ph.D., scientist Michelle Janelsins, Ph.D., MPH, from Wilmot’s Cancer Control and Supportive Care Research program and Giovanni Schifitto, M.D., M.S., a professor of Neurology and Imaging Sciences.

“Rochester is one of the few places where you can find this unique combination of mentors,” she says.

Providing a variety of mentors is intentional, Janelsins explains.

“We’re very multidisciplinary,” says Janelsins, who co-leads the University of Rochester’s Cancer Control Research Training Program, which is funded by a T32 grant from the National Cancer Institute.

“Any trainee who comes through the program doesn’t have just one mentor. They have a whole mentoring team, and we are helping them to conceive and execute their

Wilmot Cancer Institute

9

own pilot study so they learn to develop something that’s their own that they can take and develop their career.”

Like Hardy, Gilmore has a set of mentors from diverse backgrounds whose interests align with hers. She is studying the impact of an anti-inflammatory dietary supplement called EGCG on chemotherapy-associated frailty. Her mentors include Janelsins, as well as Supriya Mohile, M.D., M.S., an expert in geriatric oncology, and Luke Peppone, Ph.D., whose research focuses on nutraceuticals.

“They’re helping you, but not spoonfeeding you,” Gilmore explains. “You really are learning how to be able to stand on your own two feet as a researcher.”

Gilmore also finds support from her peers, who come into the program from very different backgrounds. The program typically has four trainees at a time, and they’re a mix of M.D.s and Ph.D.s who have a common interest in cancer control and survivorship.

That diversity of perspective is a key feature of the program. It not only helps teach how to work in a collaborative and multidisciplinary environment, it also helps generate new ideas.

And those new ideas are the point, says Karen Mustian, Ph.D., MPH, one of the core Hematology/Oncology fellows train in the microscope room at Wilmot Cancer Center.

Who’s who Medical students: These students are in a four-year graduate program designed to train physicians. In addition to classroom and laboratory-based education, they must complete two years of clinical rotations, during which they shadow residents and attendings in a variety of specialties.

Graduate students: These students are pursuing either a master’s degree or a Ph.D. in a particular science. In addition to classroom education, they gain research experience by rotating through different laboratories, working on a variety of projects.

10 find us on Facebook, Twitter and Instagram

Residents: These medical school graduates must undergo supervised, hands-on training called a residency in order to become licensed physicians who can practice independently. Residencies, which can last from three to seven years, provide additional training in a specialty, such as radiation oncology or internal medicine.

Fellows: Fellows are licensed physicians who have completed a residency and opted for further, in-depth training in a subspecialty, such as hematology/oncology or surgical oncology. Fellowships can last one to three years, depending on the subspecialty.

mentors in the Cancer Control Research Training Program.

“When you get a bachelor’s degree or master’s degree, you learn how to digest current knowledge and how to use it,” Mustian says. “What you don’t really learn in any of those degrees is how to create new knowledge. It’s one of the most challenging things that our trainees have to learn when they come here.”

Focusing on the practical

patients and families, but also what matters to them.

At Wilmot, trainees must also learn how to Since the 1970s, the University put that new knowledge into practice. of Rochester has emphasized the “It’s a huge leap between a theoretical biopsychosocial approach in medical community where you can banter around education. This model, developed by ideas and one where you actually have to two researchers at the university, looks put some rubber on the road and say, ‘This at the impact of biology, psychology, may be helpful,’” says Gary Morrow, Ph.D., M.S., who began training Grasshoppers over and social and environmental factors 30 years ago. He received funding from NCI on an individual’s health. In particular, it emphasizes the importance of relationships 15 years ago to start the Cancer Control in providing health care and understanding Research Training Program, which is now internationally known and which he co-leads a patient’s history in the context of their life circumstances. with Janelsins.

The School of Medicine & Dentistry is In order to do that, Wilmot’s team and also credited with developing the Double trainees have to understand not only the Helix curriculum, which, in the tradition impact of cancer and its treatment on

Attendings: Also known as attending physicians, they are licensed physicians responsible for a patient’s care in a hospital or clinic. An attending may also supervise and teach medical students, residents and fellows involved in the patient’s care.

of the biopsychosocial approach, weaves in behavioral and social sciences with traditional medical education. The goal is to prepare physician leaders who can practice in a dynamic and changing health care environment and meet the needs of diverse patients.

These values also permeate the postgraduate training programs. At Wilmot, they are reflected in the emphasis on survivorship and the late effects of treatment, as well as in the support for training in research.

“Learning about cancer and the treatments is very different from understanding all the issues related to surviving that cancer with the best possible quality of life,” says Louis “Sandy” Constine,

Post-doctoral fellows: Also known as post-docs, these researchers have completed a Ph.D. and are engaging in a period of mentored research and/or training to help them establish their careers.

Wilmot Cancer Institute

11

Surgery resident Zhaomin (Tim) Xu, M.D., says lessons in communication and leadership are valuable aspects of his training.

M.D., who served as the Radiation Oncology Residency director for 15 years and was named Educator of the Year in 2018 by the Association of Residents in Radiation Oncology. “In order to do that, you have to figure out and address the patient’s needs and what threatens them in the future. Mostly, we want our residents to be empathetic, dedicated, curious, and to learn how to learn.”

To address this need, the residents and the Hematology/Oncology fellows take a course focused on survivorship care, led

by Michelle Shayne, M.D., co-director with Constine of Wilmot’s Judy DiMarzo Cancer Survivorship Program.

“We’re one of the few programs in the country to give exposure on this,” explains Michael Milano, M.D., the residency program director. “It’s important because you do what you can to reduce risks and also help patients understand what the risks are.”

Teaching the intangible Effective communication and leadership are hallmarks of Rochester’s approach to care and research. While these topics are covered in coursework, some of the best lessons come through experience.

“Not everything is taught in courses,” Constine says. “There are always ways in which one can instill hope in a patient appropriately, and that’s hard to teach.

12 find us on Facebook, Twitter and Instagram

But it’s something that can be shown by example.”

Wilmot’s programs include one-on-one communication training that allows them to practice the art of communicating tough news. The residents and fellows also get to see the attending physicians and their teams using those techniques in the clinic.

“It’s watching what they do, seeing their interactions with patients and getting to learn from that,” says Jason Zittel, M.D., who will finish his Hematology/Oncology fellowship this summer and join Wilmot’s faculty, practicing at both at Wilmot Cancer Center and the Ann and Carl Myers Cancer Center at Noyes Memorial Hospital in Dansville.

“You’re not just a note-writer,” Zittel says.

“You go in to see the patients first, and many times, you go back in with them, and you watch how they go through a similar

conversation as you just had, seeing what worked, what didn’t work for you, and then you get to see how they do it.”

General Surgery residents have a similar opportunity to learn communication and leadership.

“A lot is watching in the operating room — how to interact with scrub techs, how to interact with nurses,” says Zhaomin (Tim) Xu, M.D., who is in his sixth year of residency and plans to pursue fellowship training in colorectal surgery. “It’s not always a natural thing to take leadership in a situation.”

The residency program supplements those lessons with an annual retreat that focuses on leadership skills, teamwork and how to inspire others to excel. In addition to talks and discussion sessions, the retreat features activities like passing a hula hoop along a rope from one person to the next while navigating different obstacles.

“It helps us practice effective communication, so it’s not just yelling,” Xu says, which is essential in a pressure-filled environment like the OR.

Finding family among peers Post-graduate training in medicine and science can be very stressful, and in recent years, accrediting agencies — particularly for medical training programs where work hours and lack of sleep have come under

Wilmot Fellowship supports ‘trajectory of learning’ scrutiny — have pushed for more attention on wellness for trainees.

On top of the pressures of training, the practice of oncology can be emotionally draining. Coursework can provide a formal outlet, but Wilmot’s programs also provide extracurricular support — everything from throwing baby showers and giving care packages to hosting baseball games and family picnics.

Wilmot also offers a training environment unlike those portrayed on TV that are dominated by cutthroat competition.

“I trained at a small community hospital for residency,” says Bahar Moftakar, M.D.,, a first-year Hematology/Oncology fellow.

“So I was nervous coming to Rochester to see if there was going to be that kind of competitiveness, but I’ve seen the exact opposite. All the fellows are incredibly helpful.”

In Surgery, there’s a certain degree of competition, says Xu, “especially when you get so many Type A people together. But in general, it’s very collegial. I consider my coresidents to be family because Surgery is a hard residency to go through.”

For Gilmore, joining the Cancer Control Research Training Program was also like gaining a new family.

“You get this all-around type of support system, not just as scientists, but as human beings, because we have so many other things going on,” she says. “We don’t just work on our grants and on papers. You know, we have kids and we have to go to different things, and you really learn about how to manage that work-life balance.”

And that support continues even when trainees have moved on.

“Once you’re a Grasshopper, you’re a Grasshopper for life,” Gilmore says of the support from the Cancer Control Research Training Program. “It’s not like you come here and they keep you for two or three years and then they send you out. You have this for life.”

Wilmot’s support for education continues beyond formal medical and scientific training to professional development for faculty and staff.

“Given that this field is wholly dependent upon novelty and science to provide patients the best care possible and to help them live longer and with better quality of life, we are on a career trajectory of learning,” says Carla Casulo, M.D., Wilmot’s Assistant Director of Mentorship & Career Development.

Wilmot has a special mechanism devoted to this kind of ongoing training. The Wilmot Cancer Research Fellowship is for physicians who have completed their post-graduate training and are on the cusp of their research careers.

“Wilmot sees the value of protecting junior faculty’s time in this transition period,” says Melissa (Kah Poh) Loh, M.D., who received a Wilmot fellowship this year.

The program was created more than 30 years ago on the wishes of local businessman and philanthropist James P. Wilmot, the cancer center’s namesake. Funded by the James P. Wilmot Foundation, the three-year fellowship is highly competitive, and it has funded the research of more than 100 physicians.

These projects have improved existing cancer therapies, provided better understanding of the mechanisms by which cancers develop and progress, and improved the understanding of the risks and challenges that cancer survivors face.

Loh’s project, for example, will look at whether a Wilmotdeveloped exercise program delivered using a tablet will help frail older adults with conditions such as leukemia and myelodysplastic syndrome maintain their functional abilities, allowing them to receive treatment longer and with a good quality of life.

“The population I’m studying is underrepresented and not being evaluated very much in the research setting,” Loh says. “And the intervention can be adapted to facilitate future dissemination and implementation.”

One of the earliest Wilmot fellows was infectious disease specialist William Bonnez, M.D., who made the discoveries that led to the development of the human papilloma virus (HPV) vaccine, one of the only vaccines in the world to prevent cancer. Bonnez and his colleagues Richard Reichman, M.D., and Robert Rose, Ph.D., created virus-like particles to mimic HPV, and they showed that exposure to these particles could generate neutralizing antibodies that would keep the actual virus from infecting human tissue.

“Without the fellowship, the work would never have happened,” Bonnez told Dialogue in 2014.

Since the vaccine was introduced in 2006, rates of HPV infection in the United States have declined significantly, and researchers are just beginning to see reductions in the incidence of HPV-related cancers, which can take a decade or more to develop.

Wilmot Cancer Institute

13

By Leslie Orr

She is the oldest of eight, the daughter of chemists. Her mother died when she was just 10. In high school, she was a multisport athlete, earning 13 varsity letters while taking advanced classes and working at Burger King. She went on to play varsity softball in college. She can easily spot a team player.

“The whole is greater than the sum of the parts,” she likes to say.

Based partly on a love of Nancy Drew and Encyclopedia Brown books as a child, she decided that detective work in a science lab was a perfect career option and settled on biochemistry.

Meet Paula Vertino, Ph.D., the Wilmot Distinguished Professor in Cancer Genomics, and the cancer institute’s highest-level leadership recruit in several years. Her priority is to help Wilmot in the lengthy and rigorous review process to achieve National Cancer Institute designation as a top cancer center in the country. When Vertino agreed to leave Emory University’s Winship Cancer Institute in 2018 and come to Rochester, it was a strategic homerun for Wilmot — because she sits on the NCI-A committee that oversees the review of NCI-designated cancer centers nationwide. She laughs at the idea of being a “secret weapon,” but agrees that her experiences and insights should help Wilmot become a stronger organization.

A western New York native and die-hard

14 find us on Facebook, Twitter and Instagram

Buffalo Bills fan, Vertino packed up a 22year career in Atlanta, bought a snowblower and joined Wilmot at a critical time in its history. She brings a playbook on problemsolving, team building and how to woo the NCI. We sat down to talk. Following is an edited version of the transcript.

Congratulations and welcome to Rochester! Tell us about yourself and how you operate.

I’m known for my laid-back attitude.

I’m often here late, and I’m known for wandering the halls in the middle of the night. (laughs) I am known as someone who brings people together and as a resource for knowing who’s doing what and where.

At Emory, I was one of those people who knew what everybody was working on.

Hopefully I will be able to know all of that soon in Rochester. I was connected because I participated in a lot of different groups — from being strongly involved in the graduate training programs and in my interactions with basic scientists, but then I’ve always had my laboratory in the cancer center and been very close to the clinical enterprise as well. I’ve moved between those two worlds very easily. That’s what I hope to bring to this job.

Part of the reason I chose to come here

Vertino believes in the “360 approach” to research: The best ideas come from teams of individuals who know that basic science informs patient care and that patients and oncologists inform basic science.

is that I like being in an academic cancer center that’s embedded in a university. I like being at a place where I can run the gamut.

For example, I can talk to my epigenetics colleagues about the nitty-gritty biochemical aspects that drive gene regulation in different organisms on one night and then talk to a translational breast cancer group another night. That happens quite often.

Was your family the biggest influence on your life trajectory?

Certainly my family had a very big impact, with family dynamics and things, and being the oldest. When it came to choosing a college, I did not go and visit a bunch of different places. I looked at the old Peterson’s Guide… I decided on my path very early on — a biochemistry major and That’s either a gift or a skill, right? a Ph.D. — even though I didn’t understand Seeing the big picture and being able what that entailed. And the two in-state to function in different worlds and schools that offered biochemistry were UB pull those common threads seems to and Stony Brook University. I didn’t want to be fairly unique in the research world. stay in Buffalo, so decision made! I took a lot of advanced classes in high school and Well, yes, scientists like to dive down, not was able to graduate from college in three out. I think it’s just a matter of listening. And years. you have to be open to asking questions and My first year at Stony Brook, I took to not be afraid of what you don’t know. … Advanced Organic Chemistry with a six-hour You have to sort of move out if you want lab, and I loved it. I started doing research to learn something new. I think I’m good at with one of my professors in organic chem, that. Because I like to listen to people talk and I have a paper published from that about their own research, it allows me to undergraduate work. That made a big put things together later on. impact.

You started to see life as a scientist?

Yes, I was one of those weirdos who actually liked organic chemistry. They used to give you these mixtures of chemicals, and you had to figure out how to separate them and identify them. I just loved that. It was like detective work. I loved detective stories when I was growing up — I was a big fan of Encyclopedia Brown and, of course, Nancy Drew. I read every one of those books.

Maybe research was imprinted way early, figuring out puzzles.

I had a great experience in my undergraduate years. And because I also played varsity softball at Stony Brook, it meant that every afternoon for the whole spring I was occupied with practices or games. It meant me doing my research in the middle of the night. It wasn’t uncommon for me to be doing an experiment and studying at the same time. I wouldn’t trade that experience for the world. Not a minute of it.

Wilmot Cancer Institute

15

Did it show you how to balance life and juggle different things at once?

Yes, I think so. It just seemed normal at the time, but it exhausts me to think about it now. I also played four sports a year during high school — field hockey, volleyball, basketball and softball. At some point, I figured out how to balance things. And I worked at Burger King in high school and during the summer and winter breaks when I was home from college.

I think these types of experiences teach you to get along with lots of different people in different environments. It’s like what I was saying before — you have sports practice, and that was one group of people focusing on one goal, and then you move from that to Burger King, where it was another group of people with a different goal. I do think that being involved in team sports ultimately impacts you as an adult and how you behave in a team setting. You figure out early on that you can’t be the center of attention at all times. You have to work with everyone else, and that’s going to mean making some compromises.

Another very defining experience for me was during my post-doc years, when I was at Johns Hopkins University in the cancer center. That’s when I started working side-by-side with medical oncology fellows in the lab. It was really one of the things that underscored the power of translational research for me. I knew the molecular biology side of the equation and my medical oncology fellow colleagues were treating patients. So, they, of course, knew what was important and what the clinical questions were.

16 find us on Facebook, Twitter and Instagram

Wilmot has expanded its mission significantly in the past few years and now has a goal of becoming an NCI-Designated Cancer Center. Since you’ve been embedded in that review process with the NCI for several years, is it fair to describe you as our “secret weapon”?

I guess so, but I’m not sure it’s very secret! (laughs)...

Our job is to convince the NCI “Why Rochester?” when there are already seven cancer centers in New York state — six in New York City and one in Buffalo. I don’t think it’s insurmountable, but it’s something we’re going to have to do very well. At the end of the day, that’s what the NCI is going to ask us.

research together and bridge the gap from very basic science to more applied cancer center clinical work. My vision would be to successfully achieve that. For example, we have excellent research happening in the area of radiation toxicities. We have a fantastic group in pancreatic cancer research. We have exciting work in cancer cell metabolism. But how can we move this science into a translational setting that will ultimately inspire more clinical trials?

Seeing those activities come together with achieving multi-investigator project awards and clinical trials — that will be our big success.

Not only will activities like that help with the NCI grant application, but more importantly those types of connections are real evidence of how the whole is greater than the sum of the parts.

What have you learned in your first few months here?

For me, everything is a learning experience because I spent almost 22 years in the same institution and grew up professionally in that place. It’s very different coming into a leadership position that you’ve been given as opposed to growing into it. I have fresh eyes. You don’t necessarily know the history, you have no preconceived notions. You can take everything at face value and draw your own conclusions.

Everybody at Wilmot and the University has been as friendly as was reported. People always talk about the collegiality at URMC and it has been true. I think it’s been easy to figure out where people are coming from…

There’s already strong research going on here. So it’s about how we package the

We haven’t talked about your own research yet. What is your elevator speech on epigenetics and how is it relevant to cancer?

Every cell in your body has the same DNA. Their functions are different. Liver cells, for example, make bile and break down food, and skin cells protect you from the environment. Epigenetics is how different cells maintain their specific identities. This is by controlling which genes are on or off in a particular timeframe and context.

I like to use the analogy of calico cats — which have been my favorite since I was a little girl. Calicos are almost always female.

And the reason their coats are patched, made up of two colors, is because of X chromosome inactivation. Female mammals, including humans, are born with two X chromosomes, one from your mom and one from dad. But early on during development, when the embryo is only comprised of eight cells, one of those X chromosomes is shut down. All the genes are off and it stays that way the rest of your life — and the X chromosome that shuts down in each of the eight cells can be from either mom or dad. It happens at random. Every cell that

Vertino and her cat, Abigail. As an expert in epigenetics, she says that calicos, a female breed with distinctly spotted coats, represent X-chromosome inactivation and serve as a visual example of epigenetics. “I’ve always had calico cats since I was a kid and long before I knew anything about epigenetics,” Vertino says. “It turned out to be fortuitous.”

descends from each of the eight cells then remembers which X chromosome is on and which one is off. And so, in cell No. 1, if the X chromosome you got from your father is shut down, every cell that descends from that cell to make the whole human being remembers to turn off the paternal one.

The reason the calico cat is a mosaic is because the gene that determines the coat color is on the X chromosome. And depending on which X chromosome is off — mom’s or dad’s — that creates the orange or black patches. In humans, it’s the same.

Females are also a genetic mosaic in terms of X-chromosome activation. You can just see it better on a calico cat.

At the molecular level, the connection to cancer occurs when the epigenetic patterns are changed: Some genes that should be on are turned off, and others that are off are inappropriately turned on. The program is changed, and cells lose their normal identity.

The DNA itself is intact, but it’s packaged inappropriately. This is a reversible change.

One of the big efforts, naturally, concerns

reprogramming the cancer epigenome back to a more normal state.

It’s exciting to think about reprogramming cancer cells and re-sensitizing them to drugs to which they’ve become resistant. Also, there’s a lot of interest in reprogramming cancer cells to make them more sensitive to immunotherapy. By using inhibitors of epigenetic regulators, it can make tumors more visible to the immune system. You’re doing more than just priming the immune system; you’re making the tumor cells more visible.

Outside of the lab, how are you acclimating to life in Rochester? We hear you’re a craft beer aficionado.

Monroe Avenue. Jeremiah’s has great wings and I can watch the Bills. It was my haunt last fall.

So you are a Buffalo Bills fan. Do tell!

There’s only one way to be a Bills fan — you have to be a die-hard. There were only two times that the Bills came to town to play the Falcons in the whole 22 years I lived in Atlanta — and I went to both games.

Most recent was the 2017-18 season, and the Bills won. Yay! It was very exciting, a beautiful day. … I think there were more Bills fans at that game than Falcons fans — at least we were louder!

I do like to go out for beers with scientists. (laughs) I’m making my way through the small breweries, which are all over Rochester. I live in the Cobbs Hill area of Rochester and it only takes me 15 minutes to get anywhere! And I’ve discovered The Little Theatre and Jeremiah’s restaurant on

Wilmot Cancer Institute

17

Investigators Look to a Better Future for Patients with Bladder Cancer

By Leslie Orr

Manny Tuccio, a 53-year-old husband and father of three, has a striking family history of bladder cancer. His grandfather passed away from the disease in the 1980s. His father was diagnosed with it a decade later and only survived for two years.

When Tuccio was diagnosed in 2017 with bladder cancer, however, his luck started to change because a research boom was underway at the Wilmot Cancer Institute and across the country.

In fact, Tuccio was eligible for the latest bladder cancer intervention available, in a clinical study led by Wilmot. After his tumor was removed in the operating room, surgeons immediately instilled chemotherapy through a catheter that flowed directly into the bladder area. The trial allowed doctors to evaluate this simple, post-surgical step with the drug gemcitabine in patients with low-grade bladder cancer, to find out if it would reduce a tumor recurrence. Gemcitabine costs less and has fewer side effects than other drugs that have been used in this way.

Tuccio’s physician, pioneering urologist Edward Messing, M.D., led the landmark national study. Dozens of urologic surgeons at 23 cancer centers took part, and the results showed a 34-percent reduction in cancer recurrence for patients who received the treatment.

18 find us on Facebook, Twitter and Instagram

Manny Tuccio, here with his wife Nancy and son Nicholas, was diagnosed in 2017 with bladder cancer. At Wilmot, he participated in a clinical study of a new technique using chemotherapy immediately following surgery.

Today, Tuccio is among those who remain free of bladder cancer. “I don’t think I would be here now,” he says, “if I had gotten bladder cancer 10 years ago.”

The Journal of the American Medical Association (JAMA) published Messing’s study last year and lauded it as “practice changing.” Afterward, University of Rochester Medical Center Urology resident Jacob Gantz, M.D., launched a local implementation study to create guidelines that would improve the rates of infusing gemcitabine in the operating room. As a result, rates of usage jumped from less than 40 percent to more than 80 percent — and counting.

“This success indicates that we may become a model for other institutions,” Gantz says.

As one group of scientists, led by Messing and Gantz, steers discoveries into real-world practice, another group is exploring bladder cancer at its molecular roots.

Wilmot research by Chawnshang Chang, Ph.D., Yi-Fen Lee, Ph.D., Hiroshi Miyamoto, M.D., Ph.D., and Shu-Yuan Yeh, Ph.D., is revealing new insights into what drives the disease and possible new treatment pathways.

And for the approximately 25 percent of individuals who are initially diagnosed with the more serious type of bladder cancer, which has invaded the muscle wall, more than 50 percent will develop metastatic disease and face a median survival of only about 15 months. No new widely accepted treatments have emerged for advanced, metastatic disease in decades.

For these reasons, bladder cancer represents the highest lifetime treatment Data and Gender Questions cost per patient in the U.S. — a statistic that warrants a full commitment to improve Bladder cancer is one of the trickiest cancers outcomes, says Lee, who focuses on how to to manage. stop bladder cancer from spreading.

Although most people, like Tuccio, are The Rochester region also has a higherdiagnosed with a lower-risk subtype known than-average incidence of bladder cancer. as non-muscle invasive cancer, two-thirds The national average is 19.5 cases per of them will still see the cancer return 100,000 people but within the 27 counties within five years and 88 percent of low-risk in upstate New York from where Wilmot patients develop a recurrence by 15 years. draws patients, there are 27.3 cases per This requires close monitoring throughout 100,000, according to National Cancer patients’ lives — and the surveillance is Institute data. not easy. It involves invasive cystoscopy, a In another twist, men are three times procedure where a small tube with a lens is more likely than women to get the disease. inserted through the urethra into the bladder More than a decade ago, Chang and to look for new lesions. Patients experience Miyamoto, who at the time was a research pain and repeatedly lose valuable time to assistant professor in Chang’s laboratory, recovery. made a critical connection between the

“It has been a big year for advances in bladder cancer,” says Messing, a professor of Urology who was honored last year with a festschrift in the journal Bladder Cancer for his lifetime of remarkable scientific achievements. “As a result of research, there’s much more hope for advanced bladder cancer and we’re also discovering smarter ways to manage lower-burden disease.”

Wilmot Cancer Institute

19

established his own lab at Wilmot. His team discovered that AR is partly the reason why bladder cancer cells are often resistant to the chemotherapy drug cisplatin and to radiation treatment; they’ve also explored ways to make the cells more sensitive to chemo and radiotherapy. Another study, a clinical trial involving 162 Japanese men who had both bladder and prostate cancer, showed that androgen deprivation therapy — a standard treatment for advanced prostate cancers — might also reduce the Shu-Yuan Yeh, Ph.D. risk of bladder cancer recurrence, especially in patients with bladder tumors that test androgen receptor (AR) — which controls positive for the AR biomarker. male hormones such as testosterone — Miyamoto recently won a $150,000 and bladder cancer’s development and Ferring Research Institute innovation grant progression. to focus on a key molecule regulated by the Their discovery helped to debunk androgen receptor and related to cisplatin some old theories about why men have a resistance. remarkably higher incidence. With smoking Lee and Shu-Yuan Yeh bring a different as a major risk factor for bladder cancer, perspective to the disease — with Yeh doctors used to believe that men were highlighting the role of the female hormone diagnosed more often because more men estrogen and estrogen receptors in bladder smoked cigarettes. But that theory blew up cancer. when smoking rates soared among women Yeh discovered that estrogen receptorand the men-to-women bladder cancer ratio alpha (ER-alpha) may play a protective role stayed nearly the same. Exposure to toxins in in the initiation of bladder cancer while manufacturing and industrial jobs is another estrogen receptor-beta (ER-beta) may fuel risk factor. But even as more women entered it. The yin and yang roles of estrogen, with the workforce, the three-to-one bladder the receptors countering each other and cancer ratio didn’t budge. balancing out the ER activity, may explain

why females have a lower incidence of bladder cancer than males, she says.

Recently, Yeh’s lab further delineated the roles of estrogen receptors by demonstrating their involvement in tumor metastasis.

Lee has several new research developments as well.

In a study published this year by the journal Scientific Reports, Lee showed how a new tool that her lab developed can help direct attention toward bladder cancer metastasis.

Lee specializes in why bladder cancer prefers certain sites for colonization away from the original tumor. She studies the tiny vesicles released from cancer cells that contain DNA and RNA and how they nurture metastasis. Her lab has identified biomarkers that can detect vesicles in lymph nodes, urine, and blood from patients who have the muscle-invasive type of bladder cancer. The goal is to understand how the vesicles and their proteins support the survival of new cancer growths — and how to interfere with that process through drug therapy.

Lee is in the final stages of negotiating a two-year grant for $600,000 to begin on Sept. 1. The funds will support vesicle investigations as well as how cigarette smoke and flavored e-cigarettes may impact vesicle activity.

Lee also studies the mechanics behind

Hormones: Bladder Cancer’s Fuel With the androgen receptor gene in play, investigators began focusing on the hormonal pathways.

Chang, the George Hoyt Whipple Distinguished Professor of Pathology, Urology and Radiation Oncology, has continued to study why AR drives bladder cancer and the connection between testosterone and bladder cancer cells.

Miyamoto has also continued to show in multiple, peer-reviewed journal articles new information about how AR signals promote bladder cancer growth. A professor of Pathology and Urology and director of Genitourinary Pathology, Miyamoto

20 find us on Facebook, Twitter and Instagram

Urologist Edward Messing, M.D., and Urology resident Jacob Gantz, M.D., are studying the use of a chemotherapy called gemcitabine immediately after bladder cancer surgery.

Hiroshi Miyamoto, M.D., Ph.D., center, and his team Takuro Goto, M.D., and Yujiro Nagata, M.D., study how androgen receptor signals promote bladder cancer growth.

Bacillus Calmette-Guerin, an immunotherapy treatment for early stage bladder cancer.

BCG is derived from a weak strain of a bacteria used in the vaccine against tuberculosis; it is usually injected directly into the bladder. Her team is investigating why some patients don’t respond to BCG treatment and they’re searching for biomarkers that predict treatment response.

Chang, in a separate investigation, also discovered that BCG plus anti-androgen therapy was more effective than BCG alone in destroying bladder cancer cells.

“We’re on our way to becoming a bladder cancer destination center,” Messing says.

“Right now, we’re scratching the surface on so many developments and we have more things to pursue in the future, including the role of the microbiome (gut bacteria) and its influence on treatment, and improvements in immunotherapy.”

Meanwhile, Messing adds, the U.S. Food

and Drug Administration approved five immunotherapy drugs for bladder cancer in the past couple of years, providing options for patients as bench science continues to churn.

‘Changing the Mindset’ Gantz, the Urology resident who works with Messing, is devoted to speeding up the time it takes to bring new treatments to patient care.

He conducted a further analysis of Messing’s gemcitabine study, for example, to uncover what types of logistical barriers might prevent surgeons from using the new approach in the operating room.

Is it training, insurance issues, or perceived inconvenience? An older chemotherapy drug that had been similarly used years ago was much more expensive and came with a lot of side effects —

casting a dark cloud over the idea of instilling any type of chemotherapy in the operating room, Gantz says.

But he was undeterred. Funded by a small grant from the Urological Care Foundation, in just six months Gantz gathered data and spoke to attending physicians, residents, pharmacists, operating room schedulers, operating room nurses, anesthesia specialists, and staff. He educated the group on the benefits shown by the new study. The team created an automated report in the URMC electronic medical record system with a streamlined way to order gemcitabine into the operating room. He even hung posters in the ORs and urology clinics.

“It’s about changing the mindset,” Gantz says. “If you encourage people and point out how things can be different, it can change.

Eventually, people understand this is worth pursuing.”

Gantz’s study is largely responsible for the soaring new rates of gemcitabine usage for eligible bladder cancer patients, based on Messing’s groundbreaking protocols.

“This is medical innovation,” Gantz says, “and the whole point is to take these discoveries and make them work for our patients.”

Wilmot Cancer Institute

21

NEWS BRIEFS

New York State Supports Recruitment of Wilmot Scientists With a $1 million grant, the University of Rochester and its Wilmot Cancer Institute were among of the first institutions in the state to receive special funding for recruitment and retention of exceptional scientists.

The University used the money to bring Paula Vertino, Ph.D., from Emory University in Atlanta to Rochester to serve as Wilmot’s Director of Translational Research and the Wilmot Distinguished Professor in Cancer Genomics. The grant came from the $15 million New York Fund for Innovation in

Research and Scientific Talent (NYFIRST), and was announced in April by Gov. Andrew Cuomo.

“Translational science is essential for moving laboratory discoveries into new technologies and treatments for patients,” says Mark B. Taubman, M.D., CEO of the University of Rochester Medical Center and dean of the University of Rochester School of Medicine & Dentistry.

“This grant has allowed us to bring accomplished scientist and Buffalo native Paula Vertino back to upstate New York and

to attract three additional researchers here from across the country.”

The three additional faculty are Brian Altman, Ph.D., from the Wistar Institute, who studies the circadian clock and cancer metabolism; Stefano Mello, Ph.D., from Stanford University, who studies non-coding RNAs and tumor initiation; and Patrick Murphy, Ph.D., from the University of Utah, who studies the epigenetics of cell state transitions.

Southern Tier Oncologist Joins Wilmot Neeta Soni, M.D., of Southern Tier Cancer Care in Olean joined Wilmot Cancer Institute as Associate Professor of Clinical Medicine in May. A board-certified medical oncologist, Soni will continue to provide office visits, consultations and chemotherapy infusion services at her current location, 328 Delaware Ave. Soni also sees patients at Wilmot’s clinic at Jones Memorial Hospital in Wellsville. Soni and her staff have provided medical oncology and chemotherapy infusion services in Olean since 2003. They treat all types of cancers and will work closely with the team of subspecialists at Wilmot

22 find us on Facebook, Twitter and Instagram

to provide additional access to clinical trials and support services.

“My team and I have been committed to providing excellent and compassionate care to our underserved area and are very excited with the opportunity to expand our services to the Wellsville area, with the support of the expert team at Wilmot Cancer institute,” Soni says. “I believe the added convenience and easier access to subspecialists and clinical trials will greatly benefit our patients.”

Rectal Cancer Program Earns Special Accreditation The University of Rochester Medical Center became only the sixth institution in the country and the first in New York and the Northeast to receive a three-year credential from the National Accreditation Program for Rectal Cancer (NAPRC).

Achieving the accreditation ensures that patients will receive the most streamlined, modern evaluation and treatment for the disease, in compliance with 19 standards.

Wilmot established a rectal cancer multidisciplinary care team that includes representatives from surgery, pathology, radiology, radiation oncology, and medical oncology.

“The NAPRC accreditation is a testament to our commitment to providing cuttingedge treatments for rectal cancer,” says Fergal Fleming, M.D., a colorectal surgeon and associate professor of Surgery and Oncology, who led the efforts to achieve this accreditation. “Because rectal cancer and its treatment can have significant impact on a person’s life, our program is dedicated to ensuring that our patients receive the most appropriate care and to meeting their needs and goals.”

Strong Memorial Hospital Earns Specialty Care Designation for Cellular Immunotherapy CAR T-cell therapy is one of the newest pillars of cancer treatment, an approach that uses a patient’s own immune cells to attack the disease. UR Medicine’s Strong Memorial Hospital and Wilmot Cancer Institute have been offering the therapy for several years and in February became one of the first centers to be nationally designated by Excellus BlueCross BlueShield for a commitment to delivering improved patient safety and better health outcomes.

Under the new Blue Distinction Centers for Cellular Immunotherapy, the hospital was certified by a special program required by the U.S. Food and Drug Administration, and committed to system-wide monitoring and reporting of CAR T-cell patient outcomes. The designation was created to acknowledge

the expertise needed to deliver this complex treatment.

“Providing this stateof-the-art treatment requires multidisciplinary expertise in nursing, critical care and neurology, as well as blood and marrow transplantation/cellular therapy,” says Patrick Reagan, M.D., who has led the efforts at Strong Memorial to bring CAR-T therapy to the Rochester region. “We are committed to quality in these areas and to achieving the best possible outcomes for patients in our region who need CAR-T therapy.”

Wilmot Cancer Institute

23

NEWS BRIEFS

Family Stories Expose Gaps in Cancer Care

To benefit Wilmot Cancer Institute patients in the future, families of cancer patients who had passed away took part in a study and described three distinct experiences — “We Pretty Much Knew,” “Beating the Odds,” and “Left to Die” — in the final weeks of their loved one’s life.

Scientists listened, gathered their valuable perspectives, identified the problems, and plan to use the data for improving care at this difficult and emotionally charged time.

“All of the families in this study are telling us how we can be more helpful,” says the lead author of the study, Sally Norton, Ph.D., R.N., a palliative care expert, associate professor at the University of Rochester School of Nursing and a Wilmot investigator. “We are listening and working to do a better job.”

The research was published in the journal Supportive Care in Cancer. Investigators recorded and analyzed stories from 92 families and caregivers, looking for common threads about the final transition from active treatment to death. Most problems stemmed from misunderstandings about how the cancer would progress, or when information shared between families and the treatment team did not reflect an understanding of what was happening with the patient.

Researchers discovered that the largest

group of patients and families fell into the category, “We Pretty Much Knew.” The health care system worked for them as it was designed to do. The second largest group included patients who saw themselves as “fighters” and wanted to continually try new treatments at the end of life, but they ended up experiencing chaos near the time of death because they were unprepared. The third group — the smallest — described a crisis in their loved ones’ final weeks, and felt abandoned by the care team.

Norton and her co-investigators suggest that everyone would benefit from a standard plan that clearly lays out what to anticipate as patients in active treatment become too sick for additional chemotherapy and yet do not transition to hospice. The plan would identify actions the families can take, and emergency contact information for a clinician who could guide them.

Fitness Trackers Keep Cancer Survivors on the Move A new study shows that activity trackers such as pedometers and smartphone apps are linked to improved step counts and exercise engagement for cancer survivors.

The devices have the appeal of being convenient, home-based, and unsupervised, and they may help with accuracy of exercise logs and in some cases can serve as a communications tool for healthcare teams.

Wilmot Cancer Institute investigators reviewed the outcomes of a dozen different randomized, controlled clinical trials involving 1,450 cancer survivors who agreed to participate in studies evaluating the use of the devices for periods ranging from one to six months.

Researchers found that adherence rates were sometimes higher than 70 percent and the trackers had a positive impact on general fitness and symptoms such as fatigue. The Wilmot study was published by the Journal 24 find us on Facebook, Twitter and Instagram

of the National Comprehensive Cancer Network.

Rather than being sedentary, time spent taking brisk walks or doing other moderate-tovigorous activity tends to reduce cardiovascular risk factors, helps people manage their weight, and improves strength, endurance, and heart and lung function.

This is important because cancer survivors are often at heightened risk for short- and long-term conditions such as heart disease, hypertension, weakened bones, and diabetes.

“With increased survival rates in many cancer types due to improved therapies,

the importance of incorporating exercise into patient care is immense, as exercise interventions can have a positive impact on fitness, activity level, quality of life, and overall well-being,” said the study’s first author, Kerry Schaffer, M.D., a Hematology/ Oncology fellow at Wilmot. She received an American Society of Clinical Oncology (ASCO) Merit Award in 2018 for leading the project.

Soybean Oil or Fish Oil? The Results Surprised Wilmot Researchers A study showed, unexpectedly, that soybean oil was better than fish oil for reducing cancer-related fatigue in breast cancer survivors.

The results also raise new questions about the value of fish oil and the consumption of soy by women with breast cancer, which is controversial.

“Our study confirms that the benefits of fish oil have been overstated,” says Luke Peppone, Ph.D., assistant professor of Surgery in the Cancer Control and Supportive Care Research program at the Wilmot Cancer Institute. The research was published by Journal of the National Cancer Institute Spectrum.

For years fish oil supplements, which contain omega-3 fatty acids, have been widely used by Americans to treat or protect against a variety of ills and to promote cardiovascular health. But many studies, including a review of several clinical trials, have shown inconclusive evidence or no meaningful benefit for taking fish oil supplements.

However, because fish oil can reduce inflammation in the body, the Wilmot investigators wanted to find out if it could help with the crushing fatigue experienced by some cancer patients. Previous research has shown a link between fatigue and inflammation, and suggested that fish oil might help.

The fish-oil-versus-soybean-oil study of 80 female breast cancer survivors was designed to use soy as the comparison supplement because it contains omega-6 instead of omega-3. Soy is generally viewed as having pro-inflammatory properties rather than the more desirable anti-inflammatory properties.

All women reported a reduction in fatigue, but the most significant improvement came among the women who were taking omega-6 soybean oil and who reported the most severe fatigue at the beginning of the study.

Although soy performed well in this study, soy is eyed with caution among many women treated for hormone receptorpositive breast cancer, the most common type. The concern is that some soy products, such as protein powders, tofu, and additives in processed foods, contain isoflavones that can exert estrogen-like effects and possibly increase the risk of a cancer recurrence.

Peppone noted that the soybean oil supplements used in his study did not contain isoflavones. He also emphasized there is not enough evidence yet to support patients taking soybean oil for cancerrelated fatigue, and he advised against starting soybean oil supplements for any reason without consulting a physician and until additional research is completed.

Lower Doses, at Home. Is This the Future of CLL Treatment?

Research shows that giving antibody therapy more often but at lower doses — and perhaps teaching patients how to inject themselves at home — could be a future option for people with chronic lymphocytic leukemia (CLL) and other blood cancers that commonly afflict older adults.

Wilmot Cancer Institute researchers discovered the new treatment approach as they were investigating better ways to measure the effectiveness of some of the newest drugs for blood disorders. They determined that the high-frequency/lowdose strategy may be less toxic but just as powerful for fighting cancer. The study, led

by Clive Zent, M.D., a professor of Medicine, Hematology/Oncology, at the University of Rochester Medical Center and Wilmot, was published by Cancer Immunology Research.

Based on the laboratory work, Zent and Paul Barr, M.D., are designing a clinical trial to launch this year to evaluate their highfrequency-low-dose-at-home approach in

patients needing initial treatment for CLL. It will be funded by Acerta/AstraZeneca.

“Our new treatment method could be more effective and convenient, with lower toxicity and costs,” Zent says. “Patients could have less risk of unpleasant side effects and they could learn how to give themselves their injections at home. This could change the way we treat CLL patients

because they would not need to undergo long intravenous infusions in medical facilities.”

Other clinical trials have also shown that high-frequency-low-dose regimens may be less likely to cause acquired resistance to the drug, Zent says.

Wilmot Cancer Institute

25

NEWS BRIEFS

Prostate Cancer Researchers Find Molecular “Switch” to Prolong Survival

Wilmot Cancer Institute scientists believe they have figured out why a commonly used drug to treat late-stage prostate cancer often stops working after four or five months and appears to have a dual function that later turns the cancer into a relentless aggressor.

By describing how the drug, enzalutamide, inadvertently causes the harmful transformation, corresponding author Chawnshang Chang, Ph.D., and colleagues believe they have also discovered a way to block it from occurring, at least in mice. The study, led by Jie Luo, a graduate student in Biology at the University of Rochester, was published in the journal Nature Communications.

“As more patients look to enzalutamide to extend their lives, even for just a few months, our goal is to find ways to make the drug work for longer periods and to block the dangerous pathways that lead to adverse side effects,” Chang says.

Prostate cancer is the second leading cause of cancer death in American men.

Although some early-stage types, with a low Gleason score, can be treated with a “watch and wait” approach, other types are higher-grade cancers that require surgery and androgen deprivation therapy (ADT).

The goal of this treatment is to lower the amount of male sex hormones (androgens) in the body, which fuel the cancer. An

26 find us on Facebook, Twitter and Instagram

especially aggressive subtype of the disease is known as castration-resistant prostate cancer, which keeps growing despite treatment.

For men who have this aggressive form of metastatic prostate cancer and are no longer responding to chemotherapy, enzalutamide can extend survival by an average of five months. In 2018, the Food and Drug Administration also approved the drug to treat men who have castration-resistant prostate cancer that had not yet spread.

But enzalutamide, a pill, can cause side effects. One of the worst effects is neuroendocrine differentiation (NED), an increase of neuroendocrine cells in the prostate tumors. An abundance of NED cells makes tumors resistant to treatment.

Chang and Luo identified non-coding RNA-p21 as the main culprit for inducing neuroendocrine differentiation, by the fact that IncRNAp-21 can switch the function of a key gene, EZH2. They also showed that IncRNAp-21 is highly expressed in NED prostate tumors.

Earlier, scientists believed that only a tiny percentage of advanced prostate cancer tumors underwent neuroendocrine differentiation. But recent studies estimate that 30 to 40 percent of patients have tumors containing aggressive neuroendocrine prostate cancer cells for which the average survival rate after

detection is less than one year — making more patients vulnerable to the worst-case disease progression, Chang says.

Edward Messing, M.D., a national and international authority in urologic cancers who treats patients at Wilmot and UR Medicine, says the latest discovery has the potential to impact men with challenging cases.

“Dr. Chang’s team has identified an important molecular mechanism that affects many of the thousands of men with advanced prostate cancer who will eventually succumb to their disease,” Messing says. “Understanding and reversing the ‘switch’ that causes neuroendocrine differentiation should prolong the lives of these men and significantly reduce their suffering.”

Although no treatments are available yet in clinical trials to block the molecular switch, Chang’s lab identified a small molecule drug that appears to work in mice; researchers elsewhere have revealed similar drugs, and further study is needed.

The National Institutes of Health and the Taiwan Department of Health Clinical Trial and Research Center of Excellence funded the investigation. Chang is the George Hoyt Whipple Distinguished Professor of Pathology, Urology and Radiation Oncology.

His lab focuses on the androgen receptor and its association with several cancers.

Researchers Aim to Keep Blood Healthier, Less Prone to Cancer

CALENDAR OF COMMUNIT Y EVENTS Sept. 9 Sixth Annual Ray Dutcher Jr. Memorial Golf Tournament The tournament begins at 10:30 a.m. at Webster Golf Course. Proceeds benefit the Discovery Fund for Brain Cancer Research. To learn more, contact Jeremy Dutcher at (585) 733-7907 or jeremydutcher24@gmail.com.

As the body ages, so does the blood, raising the risk of leukemia and other blood cancers. A recent Wilmot Cancer Institute discovery showed a new way in which blood degrades when inflammation collects in the bone marrow, prompting unwanted changes in blood stem cells.

Understanding this cascade of events in the marrow, where blood is made, allows scientists to investigate the best ways to keep blood “young” and prevent cancer from developing, says Benjamin Frisch, Ph.D., research assistant professor at Wilmot.

“If we know the instigating steps in the aging of blood stem cells,” Frisch says, “we can find ways to rejuvenate blood and reduce the risk of leukemia.”

The research could have implications for all types of blood disorders and inflammation that occurs with aging, but it is specifically directed at acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), which usually occur in adults older than 65. There is no cure for either cancer, and the five-year survival rate for AML is only 28 percent.

Frisch is co-lead author of the paper, published by JCI Insight, with Corey Hoffman, Ph.D., a former graduate student in the lab of corresponding author Laura Calvi, M.D. She is a professor of Endocrinology/Metabolism and co-leader of Wilmot’s Cancer Microenvironment research program.

The findings emerged from collaborative work among many scientists in the Cancer Microenvironment program and Wilmot’s Hallmarks of Cancer basic biology research program. The Calvi lab for years has been investigating how to reverse damage to blood production; the latest study offers an important framework to further explore therapies to aid in healthy blood production and to potentially prevent inflammation.

The team discovered that a well-known inflammatory protein called Interleukin 1B is a key component in disrupting blood production in mice. Interleukin 1B becomes abundant in the bone marrow in response to a defect in a type of immune cell called a macrophage. The defect breaches the aging blood stem cell population — adding turmoil to a system that is already less efficient due to aging. The blood system transports oxygen and supports all of the body’s tissues and organs.

The research also provides more evidence that undesirable changes to stem cells occur in the surrounding microenvironment, an important area of focus for Calvi’s lab.

Several branches of the National Institutes of Health, including the National Cancer Institute, funded the research, as did seed grants from Wilmot and the UR’s Clinical Translational Science Institute (CTSI) incubator fund.

Sept. 14 17th Annual Steve Coleman Memorial Golf Tournament Held in memory of Steve Coleman, this tournament begins at noon at Salmon Creek Golf Club in Spencerport. Proceeds benefit the Wilmot Cancer Institute’s Research Fund. To learn more, contact Laura Coleman at (585) 402-6731 or lsdbcole@frontiernet.net.

Sept. 19 Fifth Annual Adding Candles for the Cure This fundraiser supports brain cancer research at Wilmot. It takes place from 6-9:30 p.m. at Locust Hill Country Club and will feature hors d’oeuvres, an auction, raffles and more. Details are available at www.addingcandles.com.

Oct. 13 Go Pink! Towpath Community Foundation Breast Cancer Bike Event and 5K This fundraiser features a 5K run, as well as 10-mile, 25-mile and 50-mile bike rides. The event begins at 7 a.m. at Mendon Ponds Park, and proceeds support breast cancer research. To learn more, contact Towpath Bike & Multi Sport at (585) 381-2808 or www.towpathbike.com.

Oct. 19 Scare Brain Cancer Away 5K This race takes place at East Rochester High School starting at 9 a.m. Proceeds benefit the patient needs fund for brain cancer patients. To learn more, visit https://runsignup.com/Race/NY/ EastRochester/ScareBrainCancerAway Nov. 16 10th Annual Step It Up! Cure Pancreatic Cancer Indoor 5K & Family Fun Day The Pancreatic Cancer Association of Western New York hosts this annual event to raise funds for pancreatic cancer research. The event takes place from noon to 4 p.m. at the Rochester Institute of Technology’s Gordon Field House. To learn more, visit pcawny.org.

Wilmot Cancer Institute

27

Discovery Ball Focuses on Fundamental Science in Cancer Research

Discovery Ball co-chairs Lois Taubman and Colleen Wilmot

The 20th annual Wilmot Cancer Institute Discovery Ball raised more than $818,000 to support the Hallmarks of Cancer research program. The program focuses on the biology of cancer and understanding the fundamentals of what makes cells become cancerous.

The event honored the Edelman-Gardner Cancer Research Foundation, which has long supported fundamental science at Wilmot, with the Inspiration Award. Over more than 30 years, the Foundation has given more than $1 million to support Wilmot scientists through pilot grants, fellowships and new equipment purchases. This support enabled

our scientists to secure over $5 million in additional funding from the National Cancer Institute and the National Institutes of Health. Together, these funds have fueled life-saving discoveries in cancers such as brain, breast and pancreas cancer.

Founder George Edelman Jr. of Hilton was inspired to support research after losing his wife and a close family friend to cancer.

The Foundation raises funds through golf, bowling and euchre tournaments; book sales and bottle drives; and motorcycle and bicycle rides.

Edelman died in April, and his sister-in-law Karen Hermance spoke at the Discovery Ball.

“George Edelman’s story is a perfect example of how it all can start with the commitment of one,” Hermance says. “When you have a strong conviction or purpose, the drive is fueled by ‘It’s never enough.’

This award gave George, the Foundation and all its loyal supporters the opportunity for a day to pause and feel some validation.

Tomorrow, we go back to ‘It’s never enough,

we need to do more.’ Cancer research is critical for all of us. Every day we are reminded of a new reason to fight. We do that now with way more hope because of Wilmot Cancer Institute’s research.”

Lois Taubman and Colleen Wilmot cochaired the Discovery Ball this year, with help from a planning committee including Kathy Landers, Beverly LeChase, Janice Linehan, Kara Maloney, Jen O’Hara, Susan Schottland, Jimmy Wilmot, P.J. Wilmot, and Keith Yeates.

“It was an honor to serve as a Discovery Ball co-chair with Colleen Wilmot and to raise funds and awareness for the Hallmarks of Cancer research program at the Wilmot Cancer Institute,” Taubman says.

“The 20th Anniversary Discovery Ball was inspirational, emotional and impactful,” Wilmot says. “We are grateful to our committee for their dedication to this very special and important event. We are also grateful to everyone who helped make this evening a huge success.”

Wilmot Cancer Institute would like to extend a sincere thank-you to our special sponsors of the 2019 Discovery Ball. Your generosity has demonstrated your strong support for Wilmot Cancer Institute’s Hallmarks of Cancer research program, as well as your commitment to our community.

INSIGHT Accurate Acoustical Inc. Mr. & Mrs. Peter & Susan Schottland MOMENT Mr. & Mrs. Richard & Marianne Bell del Lago Resort & Casino Mr. & Mrs. Peter & Kathleen Landers LeChase Construction and Affiliated Companies Mr. & Mrs. R. Wayne & Beverly LeChase CONNECTION Mr. & Mrs. Paul & Judy Linehan COLLABORATION AP Plumbing Bergmann Associates Mr. & Mrs. Ronald & Katherine Bielinis Celgene Cobblestone Capital Advisors, LLC Commodity Resource Corp Constellation Brands, Inc. DGA Builders Eastman School of Music Edelman Gardner Cancer Research Foundation Five Star Bank Hahn Automotive Mr. & Mrs. James E. & Donna Hammer Harris Beach Harter Secrest & Emery Dr. Aram F. Hezel & Dr. Britta M. Svoren

28 find us on Facebook, Twitter and Instagram

Highland Hospital Administration Interlakes Oncology and Hematology, P.C. Mr. & Mrs. Raymond & Eileen LeChase Dr. Jane Liesveld & Dr. Deepak Sahasrabudhe M&T Bank Magee & Flynn Dr. & Mrs. Michael & Kara Maloney Mark IV Enterprises Mr. & Mrs. Thomas & Carol Mullin Nixon Peabody LLP Oppenheimer Funds Paychex Inc. Mr. & Mrs. Edward & Ann Pettinella Mr. & Mrs. Doug & Diana Phillips The Pike Company Inc. Pluta Cancer Center Foundation Strong Memorial Hospital Leadership Sysco Food Services, Syracuse Dr. & Mrs. Mark & Lois Taubman Dr. Larissa Temple & Mr. Alan Winchester URMC Department of Cancer Control & Survivorship URMC Department of Department of Surgery URMC Department of Gastroenterology/Hepatology URMC Department of Neurosurgery URMC Department of Orthopaedics and Rehabilitation URMC Department of Pathology & Laboratory Medicine URMC Department of Radiation Oncology URMC Division of Thoracic and Forgut Surgery URMC Divison of HPB-GI Surgery Ward, Greenberg, Heller & Reidy LLP Wegmans Food Markets Inc.

Mr. & Mrs. Dennis & Katie Wilmot Mr. & Mrs. James & Shannon Wilmot Ms. Mary Wilmot & Mr. Timothy Wilmot Dr. Patrick Wilmot Mr. & Mrs. Paul & Tamera Wilmot Mr. & Mrs. Thomas & Colleen Wilmot Mr. & Mrs. Thomas & Genevieve Wilmot Mr. Keith Yeates OPPORTUNITY Al Sigl Community of Agencies Dr. & Mrs. Michael & Diane Becker Billitier Electric Mr. Kevin Carroll/Morgan Stanley Entercom Radio Flower City Glass Mr. & Mrs. Brian & Julie Martin McQuaid Jesuit High School Mr. & Mrs. Jeffrey & Patrice Pierce Mr. & Mrs. Thomas & Betty Richards Mrs. Kristie Robertson-Coyne & Mr. Christopher Coyne Roswell Park Comprehensive Cancer Center Sage Rutty & Company UNDERWRITING Genesee Regional Bank LeChase Construction and Affiliated Companies Mr. & Mrs. R. Wayne & Beverly LeChase Mr. & Mrs. Peter & Susan Schottland Mr. & Mrs. Thomas & Colleen Wilmot

Join us in celebrating all cancer survivors, remembering our loved ones, and supporting local cancer research.

Sign up and create your team today! Certified 5K, 10K, and 1-mile walk/run SUNDAY, SEPTEMBER 8 Highland Park Bowl • 1137 South Ave, Rochester, NY 14620

To register, purchase a sponsorship, or learn more, visit warriorwalk.urmc.edu.

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

/wilmotcancerinstitute

@wilmotcancer

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

@wilmotcancer