Dr. Santosh Kesari On The 5 Things Everyone Needs To Know About Cancer
An Interview With Savio P. Clemente
Everyone’s cancer is different. With the in-depth sequencing data on every patient’s tumor, it is clear that everyone is unique and we will be using this information to individually tailor treatments even more so in the future, not only to kill the tumor but to reduce side effects.
Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Santosh Kesari, MD, PhD.
Dr. Santosh Kesari is a board-certified neurologist and neuro-oncologist and is currently Chair and Professor, Department of Translational Neurosciences, Saint John’s Cancer Institute. Dr. Kesari is a Founder and Director of Neuro-oncology at Pacific Neuroscience Institute and regional medical director of Providence Southern California’s Research Clinical Institute. Dr. Kesari has broad interests in developing innovative approaches to cancer and neurological disorders and active in clinical research and is an inventor and advisor to many startups.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I was born in India to a very poor family but due to my grandparents and parents hard work and focus on education, we immigrated to the US when I was in elementary school. We grew up in a small town where my father worked as a family practioner. I grew up knowing that hard work and education are the only way to help others and become successful in life.
What or who inspired you to pursue your career? We’d love to hear the story.
I was inspired to become a doctor seeing my father in action and naturally loved math, science and biology. Early on, I used to have musings about the origin of the world, who we are, where we come from, and what exactly is the soul and mind. This early thinking led me to college at the Univeristy of Pennsylvania and then medical school where I naturally gravitated to neurology and in particular neuro-oncology since there such a high unmet need. I was fortunate to have met, taught, and inspired by amazing faculty, staff and colleagues over the years. I thought if I focused my intellect on the problem of cancer in the brain that I could make a meaningful impact over my career. I also did a PhD to hone my scientific skills to help me understand disease mechanisms better. Now after >25yrs, we have made tremendous progress and I feel just as energized that we are close to making a significant leap in improving survival and outcomes for our brain cancer patients.
This is not easy work. What is your primary motivation and drive behind the work that you do?
Brain cancer is such a high unmet need where all my patients uniformly die within 5yrs and most within 2 years. While depressing in many ways, I have learned to turn the tragedy we see daily to motivate myself and team to do better.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
We are innovating both in the lab and in clinic. In the lab we have developed new targeted brain tumor specific drugs that will be in tested in humans in the next year. In addition, we focus on identifying new drugs and markers of response so we can personalize treatments better. We have also developed new approaches of doing clinical trials better by testing earlier in disease course.
For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?
I have been in the field of oncology for >25yrs as a scientist and clinician and have published over 300 original articles and reviews. I have also led many clinical trials and developed innovative approaches to drug development including neoadjuvant trials and CSF pharmacokinetic and pharmacodynamic studies early to better understand drug effects in the brain. I also consult for patients across the globe to identify treatments when standard therapies have been exhausted using molecular information from the tumor.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?
Cancer occurs when a normal cell your body starts to grow uncontrolled, takes over other cells and organs, and eventually spreading throughout the body leading to early demise of the patient.
What causes cancer?
The process that leads to overt cancer occurs daily. Meaning as our normal cells divide there are errors in the DNA replication machinery. Most of these errors are caught and fixed immediately, but some escape and cells start to grow. There is second layer of protection where the immune system can recognize these abnormal cells and eradicate them. However, as we age or due to various environment factors (diet, smoking, hereditary, etc.) the immune system can be weak and miss these cells and allow them to continue growing.
What is the difference between the different forms of cancer?
Cancers in each organ are different in symptoms they cause; how aggressive they are; and how easy they are to treat and what treatments work the best. Some tumors respond well to one approach versus another.
I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?
It has becoming increasing clear that besides hereditary and environmental factors (diet, carcinogen exposures, exercise, etc) that the health of the immune system is probably the most critical factor. We have known of the role of immune system in cancer for over a century but only in the past decade have we turned that knowledge into a treatment approach that has changed the treatment paradign in oncology and will continue to transform all aspects of medicine going forward.
How can one detect the main forms of cancer?
Standard approaches have been to use imaging (ultrasound, XRAY, MRIs, etc) and standard blood tests (PSA and other known tumor markers). In past few years there has been strong push for liquid biopsies, and these have made cancer detection even less invasive since blood testing is so routine and easy. Now we are in a new era of using liquid biopsoies to diagnose cancer early in high risk and asymptomatic populations with the goal that if we identify earlier, we can cure more patients. This is still to be determined, however. In coming years this early detection paradigm will be played out and will change medicine in many ways to a preventative/proactive system.
Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?
This is good question and while we have made some amazing strides in skin, breast, GI, lung and liquid cancers using targeted therapies and immunotherapies, not all patients are cured. There still is quite a bit of heterogeneity within tumors and we do need to develop personalized approaches for rarer genetic subtypes. The odds of surviving vary dramatically between cancers and subtypes, however. For glioblastoma and pancreatic cancers, we have <2yrs survival but for many other solid tumors we have >5yrs survivals.
Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?
Targeted therapy and immunotherapy have changed the cancer landscape in past decade. They have even moved earlier into first line and even neoadjuvant approaches, and some have replaced standards such as chemotherapies or radiation.
Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?
Exercise, social connections, and eating healthy all play a role in healing. Having a positive outlook and family support is critical.
From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?
Talking to them about their concerns, worries, and if they have questions about what they heard at the doctors’ visits. Just being available to hear them and help them in small ways can make a big difference.
What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?
Many of patients ask about alternative therapies and role in cancer. I explain to them that these play a supportive role and not meant to be a substitution to traditional approaches.
Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.
- Cancer starts decades before it is apparent. We know this from decades of research and now with early detection technologies (liquid biospy) we may be able to intercept cancer formation earlier before clinical detection and prevent morbidity and mortality. For instance, a small number of cancers are discovered incidentally when a patient has an accident and XRAY or CT is done and shows an unexpected tumor.
- Nutrition, exercise, stress and mental health are critical to track as these factors predispose to cancer and/or modify how patients respond to cancer and treatments.
- Hereditary germline mutations can account for ~10% of common cancers. Several studies have shown that with the in-depth cancer sequencing we are doing now we are identifying germline mutations that have implications for other family members. I recently got a call from daughter of patient that died last year of glioblastoma in her 50s who found out that her grandmother was just diagnosed with similar tumor. We are testing her blood to see if any germline mutations that would change her and other family members risk of developing cancer.
- The immune system plays a central role in development of cancer. For this reason, immunotherapy has made tremendous progress in past 10 years and changed the treatment paradigms for many cancers.
- Everyone’s cancer is different. With the in-depth sequencing data on every patient’s tumor, it is clear that everyone is unique and we will be using this information to individually tailor treatments even more so in the future, not only to kill the tumor but to reduce side effects.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
Democratization of health records and digital data will help advance research and cures faster. Patients sharing data along with the advances in digital technologies, artificial intelligence and algorithm development will lead to faster insights and change treatments. I have been so excited by this approach that I have been helping one of the innovative startups that is making headway and helping our patients access drugs and understand why they respond or not by diligently gathering and analyzing all the clinical data (xcures.com)
How can our readers further follow your work online?
https://www.pacificneuroscienceinstitute.org/people/santosh-kesari/
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
About The Interviewer: Savio P. Clemente helps cancer survivors overcome the confusion and gain the clarity needed to get busy living in mind, body, and spirit. He inspires health and wellness seekers to find meaning in the “why” and to cultivate resilience in their mindset. Savio is a Board Certified wellness coach (NBC-HWC, ACC), stage 3 cancer survivor, podcaster, writer, and founder of The Human Resolve LLC.
Savio pens a weekly newsletter at thehumanresolve.com where he delves into secrets from living smarter to feeding your “three brains” — head 🧠, heart 💓, and gut 🤰 — in hopes of connecting the dots to those sticky parts in our nature that matter.
He has been featured on Fox News, and has collaborated with Food Network, WW, Bloomberg, Amazon, and Facebook. His mission is to offer clients, listeners, and viewers alike tangible takeaways in living a truly healthy, wealthy, and wise lifestyle.
Savio lives in the suburbs of Westchester County, New York and continues to follow his boundless curiosity. He hopes to one day live out a childhood fantasy and explore outer space.
