In 2022, Dr. Kristen Hege was recognized by Forbes magazine as one of “50 Women over 50: Entrepreneurs” and received the Duane Roth Career Achievement award for advances in science and medicine from UCSD. After a long and storied career, Dr. Hege retired from Bristol Myers Squibb in 2023 to pursue her lifelong dream of thru hiking the 2650 mile Pacific Crest Trail (PCT). In 2023/24, she published a 6-part essay series in Endpoint News reflecting on parallels between cancer research and hiking the PCT as well as her personal history with CAR-T cell R&D. She is utilizing this PCT adventure as a fundraiser to support leadership skills development of early career women physicians and scientists working in the field of cell and gene therapy. The first part of her adventure is published here with permission from ENDPOINTS NEWS.
Why the PCT?
I have spent the better part of 30 years as a physician-scientist focused on cancer research and drug development. Most of the new cancer therapies on which I have worked were inconceivable when I entered medical school back in 1984. Back then, the molecular understanding of cancer was in its infancy, the immune system was mostly a mystery, and the available tools of scientific discovery were ‘stone age’ by comparison to what is available today.
The research and development of genetically engineered cancer-targeted T cells, in which I have participated, represents one of the key advancements in the treatment of cancer and demonstrates the explosive power of co-opting the human immune system to target and kill cancer from within. This has been a 25-year journey full of excitement and setbacks, peaks and valleys, optimism and heartache, and, eventually, hard-won success with the FDA approval of chimeric antigen receptor T cells (CAR-T) for the treatment of blood cancers in recent years.
As I now take a step back from the intensity and commitment demanded by such a career to pursue another dream, thru-hiking the Pacific Crest Trail (PCT), I have discovered that these pursuits share much in common and that a career in cancer research is excellent preparation for this new audacious adventure.
The Pacific Crest Trail
The PCT is a 2,658-mile wilderness trail that starts near the town of Campo on the Mexican border in California and traverses the southern Californian desert with its mountainous “islands in the sky,” climbs and descends the crest of the Sierra Nevada Mountains in central California, extends north through Mount Lassen and the Trinity Alps, and then traverses the high desert and Cascade mountain ranges of Oregon and Washington, culminating eight miles across the Canadian border in Manning Park, British Columbia. Cumulative elevation gains along the trail approximate 420,880 vertical feet, climbing over 60 major mountain passes — the equivalent of climbing to the top of Mount Everest
from sea level nearly 15 times.
The southern desert, including the Mojave, has baking heat and unreliable access to water, the California High Sierras are often snowbound during the early summer months, necessitating training with crampons and an ice axe to avoid plummeting down a snow field, and the Northern Cascades are truly wild and remote with unpredictable rain and snowstorms at nearly any time of the year. The risks abound — scorpion and rattlesnake bites, bear encounters, dangerous water crossings, dehydration, heatstroke, hypothermia, falls, overuse injuries, and mental and physical exhaustion.
Only one in seven thru-hikers who start the PCT are successful in traversing the full length of the trail in one hiking season. Why would anyone want to pursue this grueling and risky pursuit, one might ask?
Then again, I have been asked this same question about choosing to specialize in oncology and focusing my career on first-in-human clinical trials of novel investigational treatments in patients with advanced and refractory cancers — a setting where the risks are high, failure is the norm, and patients are desperately ill, and cancer is king.
Nevertheless, it is in this phase of drug development where the unknown becomes known, and innovation and creativity rule. Thru-hiking the PCT, like cancer drug development, is an ambitious undertaking that requires intense due diligence, meticulous preparation and execution, steady fortitude and resilience, eternal optimism, and an ability to take the long view when facing the inevitable surprises, setbacks, and pivots inherent in such a pursuit — all of these are traits that are honed during a career in cancer drug development. It turns out that my career in cancer research is the perfect preparation for thru-hiking the PCT.
Preparation
Only a fool would embark on the PCT without diligent preparation; the same can be said for advancing new investigational cancer therapies from mouse into man. One needs to understand what to expect on the different sections of trail and balance risk accordingly. As with cancer research, there are no risk-
free options, just strategic choices that seek to weigh and balance risk and benefit. Should you go NorthBound (NoBo) starting in the parched desert or South Bound (SoBo) starting in the remote North Cascade Mountains? Most, including my husband and me, choose NoBo, with start dates between March and May.
If planning a NoBo hike, should you start the trail in March to avoid the searing desert heat and ensure that seasonal water sources are still flowing, or delay the start to May to avoid hiking across the still snowbound High Sierras? Should you plan to average 20-25 miles of walking per day to ensure that you get to Canada before the first winter storm closes the trail in the fall, or plan a more leisurely pace of 15-20 miles per day to avoid the risk of overuse injuries and stress fractures that might land you in the 86% of thru-hikers who are unable to complete the trail in one season? Should you carefully plan and pack six months of nutritious and well-balanced food and coordinate the shipment of 35-45 resupply boxes to waypoints along the trail, or “wing it” and assume that you can find the food you need in trail towns along the route and avoid the months of purchasing, prepping, packaging, and shipment required for the fully baked plan? And finally, what should you carry, which boils down to math and physics, balancing comfort and security against the gravitational weight of your backpack, given that every item you bring must be carried on your back for thousands of miles?
These latter choices depend on one’s personal priorities: speed versus comfort, risk tolerance versus risk mitigation, and monastic simplicity versus simple luxuries. My husband and I have debated the relative merits of carrying a 1-pound backpacking chair for the better part of six months. Some of the weight questions can be solved by money; you can spend nearly exponential sums of money to buy hyperlight gear that might enable you to get to the finish line faster, but is it worth it, and how much do you want to spend to shave off a few ounces when an extra 4-liter mandatory water carry in the desert adds nearly 9 pounds? As a physician, I plan to carry a 1-pound medical kit with a variety of medications, suture kits, bandages, and other supplies — prudent or overkill? There are no right answers and no choices without risk and cost, just a prioritization of the risks you are comfortable taking, the financial resources at your disposal, and the benefits deemed most valuable. Does this sound to anyone like drug development?
Pacing
Second only to the question of what to carry is the question of setting one’s pace. The PCT thru-hiking season is loosely bounded between March and October unless you are crazy enough to consider a full winter hiking experience.
Thru-hiking, like drug development, is difficult enough without compounding the challenge by extending the hike into truly inhospitable months. Speed is deeply enticing. A shorter hike is less expensive, less of a distraction from “real life” off the trail and highly valued by the competitive cadre of thru hikers seeking to break from the pack and
establish a leadership position — I mean, who doesn’t want to be first-in-class? Speed comes with compounded risks. However, that might lead to the wheels falling off the bus, including a cumulative and unsustainable toll on your body and mind from the relentless pressure and stress of an unrealistic pace or irreparable damage caused by the failure to carry the items needed to withstand any number of disasters without serious or even fatal adverse events.
One time-honored strategy to deal with the mental and physical toll of thru-hiking is the “zero-day.” A zero-day is a day off trail, where you do absolutely nothing. This doesn’t mean hiking just a few miles on a zero-day. It means zero miles, a true day of mental and physical rest to recharge the body and soul, take care of personal needs, and prepare to get back on the trail with renewed vigor and optimism. How many of you check your emails for just a few hours a day or take just that one business call while on vacation? I would argue that the physical and mental toll of oncology R&D is every bit as challenging as thru-hiking the PCT, and we would all benefit from treating vacations like zero days and encouraging
our teams to do the same.
Teamwork and Trail Angels
Thru-hiking may sound like a solitary pursuit, a Thoreau-inspired lone walk in the wilderness, and indeed, two-thirds of thru-hikers embark on the trail alone without a spouse or partner. As with many difficult pursuits, however, misery loves company, and exaltation is better when shared.
Thru-hikers typically self-congregate into “trail families” within just a few weeks on the trail. Disparate
individuals from all walks of life with different backstories and motivations for thru-hiking are drawn together with the common goal of completing this shared and ambitious journey and supporting their teammates to achieve a common goal. Trail families often evolve over the course of the trek as individuals slow down or speed up, opt for variable zero days, or exercise competing priorities.
Nevertheless, the spirit of the trail family persists, and most thru-hikers stay engaged with an evolving trail family for the duration of the PCT journey. Like a drug development project team, the inherent diversity of trail families is important to bring a multitude of perspectives to difficult problems, balance team members’ good and bad days, and derive benefit from the wisdom of crowds.
I have only heard positive stories about trail families. Dysfunctional trail families appear to be few and far between. It seems that the rigors and beauty of the PCT truly bring out the best in people. Perhaps the secret to building highly functional drug development teams is to send them all backpacking in the wilderness together.
Trail families aren’t the only source of support and succor on the PCT. Thru-hiking trails are also known for their “trail angels” who distribute “trail magic.” Trail angels are compassionate and altruistic individuals who take pleasure in providing unsolicited and selfless support to thru-hikers for the personal satisfaction and happiness derived from helping others in need. Trail angels stash caches of drinking water in remote waterless stretches of desert trail, set up full-spread Italian dinners at remote junctions where the trail intersects with dirt roads, surprise thru-hikers with coolers of beer and soda in unexpected locations and offer up their trail-side homes with free room, board, and laundry for hikers on their zero days.
The most extreme example of a dedicated trail angel is Donna Saufley, who established Hiker Heaven on her homestead near Aqua Dulce at the base of the San Gabriel Mountains in southern California, providing hot showers, laundry services, free home-cooked meals, and motherly comfort to literally thousands of thru-hikers for nearly two decades. In oncology drug development, our teams are motivated by working for patients in desperate need of new cancer therapies, with a goal of improving the quality of life of patients navigating the difficult journey of a cancer diagnosis and treatment. Fostering a trail angel, patient-focused mindset amongst our drug development teams unleashes the power of kindness and compassion and the personal satisfaction derived from extending aid to those in
need.
The Long View
Thru-hiking, like cancer drug development, is an exercise in perseverance and delayed gratification. The journey is long and arduous, the problems encountered along the way are many and success is far from guaranteed. To sustain conviction and increase the probability of success for a journey this challenging, one needs to foster the “Long View” mindset. This requires a clear vision of the general path from start to finish, a willingness to pivot and take alternate routes and workarounds when obstacles appear, and at times to pause, reflect and redirect one’s efforts.
This year, we already know that a contiguous path from Mexico to Canada will be nearly impossible due to the record-high snowfall in the California High Sierras this winter and the low probability that the snow will melt before late summer. Reflecting on this unexpected barrier to execution, my husband and I have decided to hike from the PCT southern terminus for 650 miles through the desert, starting in late March, while the daytime temperatures are still bearable and the “unreliable” seasonal streams are still flowing.
Reaching the southern end of the Sierra Nevada Mountains in early May, we will leapfrog forward to the northern end near Donner Pass and continue walking 1,000 miles through Northern California and Oregon to the Columbia River on the border of Washington state. From there, we will loop back to hike the 500 miles across the California High Sierras in August, when the snow has hopefully melted, and then catapult forward to finish with the final 500 miles through the Washington Cascade Mountains in September, ideally reaching the northern terminus before the first snow of the coming winter makes the trail impassable.
As with cancer drug development, the path from start to finish is rarely a straight line; by taking the long view — three steps and a leap forward and one step back followed by a final step forward — we can hopefully address the barrier imposed by the unprecedented winter snowfall and increase our overall probability of success.
I look forward to sharing updates from the trail through periodic essays such as this that will be published in Endpoints News over the next six months. Our PCT adventure will also serve as a fundraiser supporting the research of early-career women embarking on medical research careers within the Center for Cellular Immunotherapies at the University of Pennsylvania, under the oversight of Drs. Carl June and Bruce Levine, long-time collaborators and CAR-T cell pioneers. I am deeply appreciative of your philanthropic and personal support as we embark on this grand adventure.
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