The Cancer Questions Project, Part 7: Kanti Rai

Kanti R. Rai, MD, is professor of medicine at The Karches Center for Oncology Research, The Feinstein Institute for Medical Research; director of the Center for Oncology and Cell Biology, Long Island Jewish Medical Center; and professor of medicine and molecular medicine at Hofstra University Northwell School of Medicine. He has been involved in diagnosing and treating Chronic Lymphocytic Leukemia for almost 40 years and the staging system that bears his name came out of his early breakthrough research. His research led to the eventual development of idelalisib (Zydelig) as a second-line treatment for patients with CLL and ibrutinib (Imbruvica), used to treat mantle cell lymphoma, CLL, and Waldenström macroglobulinemia. He has been collaborating with other CLL scientists at The Feinstein Institute for years establishing the importance of fludarabine, now a standard-of-care treatment for CLL, and demonstrating the effectiveness of cladribine in treating hairy cell leukemia. Dr.Rai is an active investigator in the Chronic Lymphocytic Leukemia Research Consortium, the International Workshop on CLL, and Cancer and Leukemia Group B. He is a member of the American Society of Clinical Oncology, the American Association for Cancer Research and the American Society of Hematology (ASH).

Azra Raza, author of the forthcoming book The First Cell: And the Human Costs of Pursuing Cancer to the Last, oncologist and professor of medicine at Columbia University, and 3QD editor, decided to speak to more than 20 leading cancer investigators and ask each of them the same five questions listed below. She videotaped the interviews and over the next months we will be posting them here one at a time each Monday. Please keep in mind that Azra and the rest of us at 3QD neither endorse nor oppose any of the answers given by the researchers as part of this project. Their views are their own. One can browse all previous interviews here.

1. We were treating acute myeloid leukemia (AML) with 7+3 (7 days of the drug cytosine arabinoside and 3 days of daunomycin) in 1977. We are still doing the same in 2019. What is the best way forward to change it by 2028?

2. There are 3.5 million papers on cancer, 135,000 in 2017 alone. There is a staggering disconnect between great scientific insights and translation to improved therapy. What are we doing wrong?

3. The fact that children respond to the same treatment better than adults seems to suggest that the cancer biology is different and also that the host is different. Since most cancers increase with age, even having good therapy may not matter as the host is decrepit. Solution?

4. You have great knowledge and experience in the field. If you were given limitless resources to plan a cure for cancer, what will you do?

5. Offering patients with advanced stage non-curable cancer, palliative but toxic treatments is a service or disservice in the current therapeutic landscape?

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