Immunotherapy helps put colon cancer survivor back on his bike 

Trent Schilousky faced a grim prognosis after he was diagnosed with stage 4 colon cancer. But with innovative care, immunotherapy and a determination to get back to his love of bicycling, he’s achieved a full recovery.
June 8, 2022
After a successful response to immunotherapy for colon cancer, Trent Schilousky hit the road in April 2021, racking up some of the 6,000 miles he logged that year. Photo courtesy of Trent Schilousky.
After a successful response to immunotherapy for colon cancer, Trent Schilousky hit the road in April 2021, racking up some of the 6,000 miles he logged that year. Photo courtesy of Trent Schilousky.

The spinning wheels of a bicycle are a study in repetition. Feet press down on pedals, the wheels turn and begin their appointed rounds. As the pedals pump, the wheels return again and again to where they began. When the feet leave the pedals and the wheels cease to spin, they become motionless circles, frozen in orbit and seeming to have traveled nowhere.

But for the person pressing the pedals, the bike wheels become a means of transport from one world to another. Countless kids have used their bikes to test their limits and stretch their imaginations. The wheels carry them away from home and back. The trip complete, the wheels once again lie still, but always stand ready for another venture outward.

Trent Schilousky found liberation in bike riding during his childhood in Cheyenne, Wyoming. The early trips later became a cycle of memories charged with meaning.

“For most kids who have ever ridden a bike, it’s the freedom you feel,” said Schilousky, now 55. “It allows you to feel capable of doing something on your own. It gives you the confidence to stretch your boundaries. All of a sudden, the world opens up for you and is a much bigger place. That always stuck with me.”

After moving to Colorado in 1992, Schilousky was to take his love of biking to market. He opened his own bicycle shop, which had a very successful run in Loveland until 2010. After changing careers, bikes played a less central role for him than they had. But not long ago, Schilousky got back on a bike after a lengthy enforced absence. He climbed aboard not out of a sense of nostalgia but as a way once again to find new vistas, as he had when he was a kid in Cheyenne. In a sense, he rode for his life.

A tennis tumble and a shocking colon cancer diagnosis

Trent Schilousky and his partner Jackie Smith on their bicycles in August 2021. Cycling was a big part of Trent's recovery after immunotherapy helped him battle stage 4 colon cancer. Photo courtesy of Trent Schilousky.
Trent Schilousky and his partner Jackie Smith on their bicycles in August 2021. Cycling was a big part of Trent’s recovery after immunotherapy helped him battle stage 4 colon cancer. Photo courtesy of Trent Schilousky.

Early in 2018, life for Schilousky changed, not on a bike but on a tennis court. He had joined a tennis league with his partner, Jackie Smith, and was in the middle of a match when he lunged for a shot and landed awkwardly on his shoulder. He felt healthy otherwise and assumed the sore shoulder would heal.

It didn’t. Instead, a knot appeared under the collarbone and got bigger. A week later, he saw his physician in Loveland. A biopsy showed the small mass in his neck was cancerous. He had a subsequent CT scan, and around Valentine’s Day, Schilousky learned that he had stage 4 colon cancer. The malignant cells had spread to lymph nodes throughout his abdomen. He was told that he likely had 18 to 30 months to live.

He was shocked and angry. “I went from having no symptoms to being told, ‘You have cancer,’” he recalled. He and Jackie began figuring out what to do and decided to go out of state for care. After getting tests, physicians there advised him that he could get excellent treatment options close to home, at UCHealth Cancer Care – Anschutz Medical Campus – University of Colorado Cancer Center.

Schilousky had had one round of chemotherapy at a Loveland hospital prior to visiting the Cancer Center, but the treatment caused a coronary spasm and severe chest pain, and he’d landed in the hospital for several days. The cancer’s spread also meant that surgery was not an option to battle the malignant mass in his colon. However, Schilousky learned after meeting with Dr. Alexis Leal, assistant professor of Medical Oncology with the University of Colorado School of Medicine, that he had one more chance to survive his disease.

Immunotherapy for colon cancer offers a chance for recovery

Genetic testing showed he had Lynch syndrome, a disorder that predisposes individuals to a variety of cancers, especially colon cancer. Schilousky had inherited the defect from his mother and he, in turn, has passed it to his son Zairyk, now 25. Lynch syndrome inactivates one of four genes that help to repair defects in DNA that occur as cells divide and replicate. That increases the risk of the cellular mistakes piling up and driving an increase in rogue cells that form cancerous tumors.

Trent with son Zairyk. Trent’s recovery allowed him to attend Zairyk’s wedding last October. Photo courtesy of Trent Schilousky.
Trent with son Zairyk. Trent’s recovery allowed him to attend Zairyk’s wedding last October. Photo courtesy of Trent Schilousky.

Until relatively recently, Schilousky’s diagnosis would have left him with little hope. However, in late May 2017, the FDA approved pembrolizumab (Keytruda), a “checkpoint inhibitor” which works to stimulate the immune system to recognize and kill cancerous cells in patients with the mismatch repair defect and with solid tumors that cannot be removed surgically or that have spread to other parts of the body.

“This was the first time that the agency had approved a cancer treatment based on a common biomarker rather than the location in the body that the tumor had originated and covered patients with colorectal cancer that had progressed following treatment with prior chemotherapy,” Leal said.

Leal ordered immunotherapy treatment for Schilousky, initiating Keytruda once every three weeks in March 2018. He responded well to treatment with shrinkage of his cancerous lymph nodes and the mass in his colon. However, in late 2018 he had developed digestive issues that couldn’t be explained by the tumor. He had an endoscopy to look for problems in the upper part of his digestive tract, then a PET scan. The unhappy result: a tumor in the duodenum, which is the upper part of the small intestine.

Whipple procedure removes two tumors, but new problems arise

Dr. Alexis Leal, Schilousky’s medical oncologist at UCHealth, ordered and managed his immunotherapy. Photo by UCHealth.
Dr. Alexis Leal, Schilousky’s medical oncologist at UCHealth, ordered and managed his immunotherapy. Photo by UCHealth.

To address the duodenal tumor, Leal transitioned Schilousky to two different immunotherapy drugs in January 2019, combining ipilumumab (Yervoy) with nivolumab (Opdivo). The treatments reduced the size of the colon tumor enough that surgery to remove both it and the mass in the duodenum was now possible.

Without the immunotherapy success, surgery wouldn’t have been a choice, except in a life-threatening situation, said Dr. Steven Ahrendt, professor of Surgery-Surgical Oncology at the CU School of Medicine.

“If the disease has spread outside the abdomen, we don’t like to do surgery unless there is a blockage,” Ahrendt said. “But because Trent had had a great response to the immunotherapy, we were encouraged to proceed.”

After immunotherapy, UCHealth surgeon Dr. Steven Ahrendt removed cancerous tumors from Trent’s colon and duodenum. Photo by UCHealth.
After immunotherapy, UCHealth surgeon Dr. Steven Ahrendt removed cancerous tumors from Trent’s colon and duodenum. Photo by UCHealth.

Ahrendt excised both cancerous tumors with a Whipple procedure, a surgery that removes half of the pancreas, part of the duodenum, part of the stomach, the bile duct and the gallbladder. Seeking to banish all remaining cancer, Ahrendt also removed Schilousky’s omentum, a sheet of tissue hanging from the stomach that enfolds the intestines, and about a quarter of his large intestine. He then reconstructed Schilousky’s digestive system by reconnecting the remaining organs and tissue.

The surgery successfully removed cancer from Schilousky’s digestive tract. “Trent had an exceptional response to immunotherapy which made surgical resection even possible,” Leal said. But his replumbed system gave him unpredictable problems that continue to this day. A plain, untoasted bagel might go down just fine one morning but cause discomfort the next.

“I can’t digest food the same,” he said. “Sometimes it’s normal, sometimes it’s horrible. It’s a daily challenge to eat the things I want to eat.”

Recovery on a bike

Schilousky shed weight dramatically after the Whipple procedure. He dropped from about 200 pounds to just 120 and had to have a feeding tube inserted. He still had the tube in March 2020 when the COVID-19 pandemic struck. He was fearful of contracting the virus in his weakened state, so he mostly stayed inside, tethered to his feeding tube. He’d kept working at his job as a landman in the oil and gas industry up to the time of the Whipple procedure and hoped to return, but the pandemic put that on hold. He found himself confined to home. Jackie gave him vital support, but he admits he struggled to keep his spirits afloat.

“It was difficult to get motivated to do anything,” Schilousky said. “It was a dark time.”

A change came during one of those bleak days as he watched a “30 for 30” documentary on the controversial road racing cyclist Lance Armstrong. Schilousky had met Armstrong, and had admired and been motivated by his competitive fire. On this day, however, it wasn’t Armstrong’s cycling exploits that moved him. It was the images of Armstrong, head shaved and in a hospital gown, as he battled testicular cancer. Later in the documentary, Schilousky watched Armstrong get on his bike and ride around Austin, Texas, another gesture of defiance against the disease’s power over his life.

The documentary was a powerful motivator for Schilousky. “I felt bad about myself that I wasn’t trying harder,” he remembered. “I knew I had to figure out a way to get back on the bike and remove the feeding tube. I started riding.”

As the miles mounted, the body and spirit got stronger

He began slowly, by setting up a trainer in the basement of his Windsor home. He increased his time on the bike in 5- to 10-minute increments until he felt comfortable riding outside, first down the street and around the block. He steadily increased the number of loops, each one psychically returning him to his childhood excursions in Cheyenne.

“I got back to that kid thing,” Schilousky said. “My environment had been my house for a long time. When I got the opportunity to do something on my own again and expand my boundaries, it was incredibly liberating and freeing, and it drove me to want to go farther.”

He did just that. In April 2021, he rode in Grand Junction, then in the Red Rock Canyon in Las Vegas. That summer he pedaled in the thin air of Leadville. Jackie accompanied him on many of the rides, but he also cycled alone, savoring the countryside and the simple fact that he was alive and getting stronger. By the end of 2021, he had tallied 6,000 miles.

The mileage is a bit lower so far in 2022, partly because he and Jackie spent time on moving to a new place in Parker, close to the Palmer Divide, and partly because he’s back to work. But Schilousky still savors the sustenance he rediscovered on a bike.

“Cycling is still a priority,” he said. In a larger sense, he’s intent on “doing the things that are truly important” in his life. He is now cancer-free.

Living the life he might have lost

One of those occurred last October in Midway, Utah, near the Wasatch Mountains, where Schilousky watched with Jackie and his parents as Zairyk got married. It’s not lost on him that after his cancer diagnosis in 2018, it was a long shot that he’d have been in attendance.

“Hopefully Zairyk will have kids and I can be part of their lives,” he said. “Your legacy is how you have influence and leave a mark for the next generation.”

Leal said Schilousky’s future looks bright. “He continues to do remarkably well and just hit the two years since surgery mark without any evidence of recurrent disease,” she said.

Schilousky wants to be a source of positive motivation for others facing cancer and grim prospects, as he did. That could involve raising awareness of the importance of colorectal screening and genetic testing. Or it could be as simple as setting an example for someone going through hard, discouraging times, as the images of Lance Armstrong getting back on his bicycle did for Schilousky during that dark day two years ago.

“I truly want to make a difference in any way I can,” Schilousky said, “whether it is small or large.”

 

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.

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