Karnofsky winner Hagop Kantarjian: We changed the course of leukemias from mostly incurable to mostly curable

Leukemia was mostly a fatal disease when Hagop Kantarjian, a medical student at the American University of Lebanon in Beirut, first came to MD Anderson in  1978.

By the time Kantarjian was named the 2023 David A. Karnofsky Memorial Award recipient by the American Society of Clinical Oncology, all major leukemia subtypes had treatments that could produce a cure.

The Karnofsky Award is considered ASCO’s highest scientific honor.

“This is why I consider that choosing leukemia was the best decision in my life,” Kantarjian said to The Cancer Letter. “Because within the span of one professional lifetime, we were able to change the full course of all the leukemias from mostly incurable to mostly curable.”

In 1981, the two most common chronic leukemias—chronic myeloid and chronic lymphocytic leukemia—were deadly. Today, CML is functionally and molecularly curable, and CLL has a five-year survival rate of over 90%, Kantarjian said.

The survival rates for the two most common acute leukemias, too, have doubled or tripled over a span of four decades.

“Today, in ALL, the estimated four- to five-year survival with new targeted therapies added to chemotherapy—that we combined very recently—are showing four year survival rates of over 85% in acute myeloid leukemia,” Kantarjian said. “Most of the myeloid leukemia subsets are now associated also with four to five year survival rates of over 50% with the use of targeted therapy in combination with traditional chemotherapy.”

Kantarjian credits much of his professional success to the lessons passed on by his mentor, Emil J Freireich, and to the culture of the MD Anderson Developmental Therapeutics Division.

Kantarjian’s medical training in Beirut heavily focused on absorbing knowledge, he said. He came to MD Anderson in his third year of medical school in 1978 for a two-month elective, and worked with cancer experts who took a totally different approach.

This is why I consider that choosing leukemia was the best decision in my life. Because within the span of one professional lifetime, we were able to change the full course of all the leukemias from mostly incurable to mostly curable.

“This is when I realized what a wonderful cancer research paradise this was,” Kantarjian said. “I was sitting in the same room with these people who were not absorbing knowledge, but innovating on a daily basis and creating new knowledge that could help cancer research.

“I started thinking that, really, creation of knowledge is more important than absorption of knowledge.”

Freireich, in particular, influenced how Kantarjian approached his research.

“This was the first and most important lesson I learned from Freireich,” Kantajian said. “Which is not to accept knowledge as it exists, because it is true that probably 95% of the knowledge that exists today will become obsolete 10 to 20 years from now.

“So, it’s very important to continue to challenge the standards, the accepted standards, and to try to create new knowledge and innovate outside the general herd mentality that exists at any point in time.”

Years yearlier, at NCI, Freireich pushed for combination therapy for childhood ALL—a research idea that challenged clinical taboos of the time.

“You have to remember, in those days, doctors, when they encountered the child with leukemia, they said, ‘Let’s not let them suffer. Let’s let them die peacefully and with dignity,’” Kantarjian said. “When Freireich started treating patients with childhood ALL, this was heretic. Once he started doing those therapies and moved to the combination, people thought that this was crazy and that he was a criminal.”

Kantarjian, following in his mentor’s footsteps, pursued research ideas that other scientists dismissed.

“Anytime you are not in line with the traditional thinking, there are people who may get annoyed or be suspicious of the research,” Kantarjian said. “So, if you think about cancer research and research in general, there are 1% of the experts who are innovators, and they are almost always highly controversial, because when they start in their research, people disbelieve it.

“So, there’s always some form of conflict when you’re thinking outside the group mentality. And 99% of the people are generally comfortable with the existing knowledge.”

Kantarjian’s investigative pursuit of two drugs in particular—decitabine and inotuzumab—faced pushback from his colleagues.

Decitabine had been tested in Europe as a cytotoxic agent—and abandoned—but Kantarjian believed the drug might be useful as a hypomethylating agent instead. He brought the idea to MD Anderson and began an investigator-initiated IND.

From 1992 to 2002, Kantarjian’s group of researchers was the only one in the world still doing research with decitabine.

In 2006, decitabine was approved by FDA for treatment for myelodysplastic syndromes and in Europe for the treatment of older unfit AML.

Kantarjian faced similar resistance to his research and development of inotuzumab, because the drug’s sponsor, Pfizer, already had a phase III trial in place investigating inotuzumab for the treatment of lymphoma.

“When the phase III in lymphoma of inotuzumab failed, we had treated already 90 patients with ALL with that single agent, and found it’s probably more effective than intensive chemotherapy,” Kantarjian said. “So, then we went back and developed the phase III trial led by MD Anderson, that led to the FDA approval of the drug in acute lymphocytic leukemia.

Pushback is to be expected if you’re truly innovating, Kantargian said.

“Anytime you try to innovate in any field of medicine, or outside of medicine, there’s going to be a large group of experts or people who deal with the same issues that do not believe you and may have serious doubts about the research,” Kantarjian said.

“They may be watching you on the side, and until what you are proposing is proven, there’s a lot of distrust and disbelief in what people do.”

Kantarjian doesn’t worry about the future of oncological advancements, he said.

“In oncology, I think we are on a wonderful positive track where there are many new discoveries—targeted therapies, immune modalities—which are adding to the therapeutic armamentarium,” Kantarjian said. “I think cancer will be history in the next 20 years, throughout most of the cancers, if not all of the cancers.”

Healthcare inequities is one of Kantarjian’s biggest worries.

“I’m concerned about health care and cancer care in the United States being unequal, and I would like to see procedures and legislations that equalize the opportunities of cure in cancer and in medicine in general,” Kantarjian said. “I would like to see in the United States a form of universal cancer and health care that allows not only the rich to be cured, but also the poor to be cured, equally and effectively.

“It should not be the case that a person who has a good insurance or who is rich could come to MD Anderson and have access to the most innovative research with the most effective drugs—and many of those drugs will be for free on a protocol—when, on the other hand, there would be a poor person who has the same leukemia that could be highly curable and cannot access this kind of research or care because they do not have a good insurance or they do not have access to this kind of healthcare.”

Kantarjian has been vocal on the topic of high-priced leukemia drugs.

“I was shocked in 2012, when I realized that the price of imatinib and, for that matter, many of the targeted therapies, was not only expensive at the start, but had quadrupled to over $100,000 a year—even though the company had made all its profits, even though the population under treatment expanded,” Kantarjian said.

“There were more profits, yet the choice was to continue to increase the price of the drugs,” Kantarjian said. “That has been a trend throughout the years where drug companies increase the price of patented drugs by 10-12% a year.”

Kantarjian recently performed an analysis using NCI’s SEER dataset on survival in CML, and comparing it to data from Sweden—where there is universal healthcare and all patients with CML get access to regular imatinib and tyrosine kinase inhibitors.

He found that in Sweden, the 10-year survival rate for CML is 90%. In the United States, the SEER data shows that the 10-year survival in CML is still about 60-70%.

“So, there are at least 20-30% of Americans who are not getting optimal treatment in chronic myeloid leukemia, simply because they cannot afford the price of the drugs,” Kantarjian said.

Kantarjian remains hopeful that the U.S. will mitigate these inequities. He cites alternative outlets for drugs that bypass the expensive intermediaries, established by Mark Cuban and other entrepreneurs, as promising advancements.

“I think, despite a decade of advocacy, things are going to start to happen,” he said. “I’m optimistic that there are going to be new tools and innovations in cancer care and in medical healthcare where drug prices are going to be significantly lowered through such interventions and innovations.”

Kantarjian spoke with Jacquelyn Cobb, reporter with The Cancer Letter.

This conversation is also available on the Cancer History Project podcast.

Transcript

Hagop Kantarjian: Thank you very much. It’s a great honor to be the recipient of the award.

HK: In the 1960s, cancer was a big thing. Many people were dying from cancer, and it was probably the dream or the vision of many of the children to be the people who could cure cancer. It was thought of as one entity.

Then as I got close to the university time, I decided that I wanted to be a cancer expert. In those days, there wasn’t enough cancer expertise, and there were not that many treatments for cancer.

So, it was a confusing time where people would tell you that there’s really no cancer expertise, and yet I had to find out when I came to MD Anderson in 1978, that in fact, there was an extensive cancer expertise and many cancer experts who were embarking into trying to cure cancer and its different subsets with, in those days, chemotherapy added to radiation therapy and to surgery. These were the three modalities of cancer therapy when I started my training in 1980.

HK: In 1978, I was a third year medical student, and we had the option to take two months of electives outside the American University of Beirut in Lebanon. So, I took the opportunity and joined the two months of elective from the third and fourth year, and came to MD Anderson.

In those days, the two most well known institutions in cancer research were MD Anderson and Sloan Kettering, and I applied to both.

Dr. Freireich, who is one of the most wonderful cancer and leukemia experts in the world, immediately responded and welcomed me.

I came, actually, on Thanksgiving day. I ended up in Houston, and I had to wait for four days because this was Thanksgiving long weekend. I stayed in a hotel for four days waiting for MD Anderson to reopen.

I remember I walked. The hotel was about half a mile from MD Anderson on Holcombe Boulevard. So, I walked and I circled around MD Anderson, and it was all closed because of Thanksgiving. But this is how I ended up here for the next four months.

This is when I realized what a wonderful cancer research paradise this was, because we are trained at the American University of Beirut and in many academic centers to simply assimilate and absorb knowledge. And here was the place where there were about 50 people whom I used to read about. I used to read their papers and research in those days in Cancer, which was the most popular cancer journal. And yet at that time, I was sitting in the same room with these people who were not absorbing knowledge, but innovating on a daily basis and creating new knowledge that could help cancer research.

There were so many big names but the most important ones, at least in my view, were doctors Emil J Freireich, Michael Keating, Kenneth B. McCredie, Jordan Gutterman, and many, many more of these wonderful innovators that made a big impact on cancer research.

After I finished my four months of elective, I went back to Lebanon and I couldn’t wait to come back to MD Anderson. I came back in July, 1981, did my two years of fellowship, and then I chose to become a leukemia doctor. In retrospect, I think this is the only specialty that I would have loved as much as I love it today.

By luck, I ended up, through just admiring Dr. Freireich, to choose leukemia research. And it turned out to be the best decision in my life.

HK: Because over four decades, we ended up changing the course of the leukemias from being mostly incurable to mostly curable. If you think about it, in 1981 the two most common chronic leukemias, chronic myeloid, and chronic lymphocytic leukemia, were incurable. Today, chronic myeloid leukemia is functionally curable with pills. The Bcr-Abl tyrosine kinase inhibitor, the first one being discovered by Dr. Brian Druker. First one, imatinib, was discovered by Dr. Brian Druker, and then there were so many others.

So, today’s CML is functionally and molecularly curable, and almost 90 plus percent of people with CML live their normal life.

Chronic lymphocytic leukemia: In 2015, we started investigating the combination of a Bruton’s tyrosine kinase inhibitor, ibrutinib, with Venetoclax for two years of therapy. And we find now that two years of therapy can eliminate the disease in most of the patients and we have an estimated five year survival over 90%.

So, these two leukemias, the chronic leukemias, are now functionally and molecularly curable.

The acute leukemias: In 1981, the cure rate was about 20% with intensive chemotherapy. Today, in ALL, the estimated four-five year survival with new targeted therapies added to chemotherapy—that we combined very recently—are showing four year survival rates of over 85% in acute myeloid leukemia.

Most of the ML subsets are now associated also with four to five year survival rates of over 50% with the use of targeted therapy in combination with traditional chemotherapy.

This is why I consider that choosing leukemia was the best decision in my life, because within the span of one life professional time we were able to change the full course of all the leukemias from mostly incurable to mostly curable.

HK: Right.

HK: When Dr. Freireich died in 2021, I wrote several obituaries about his life, which is an amazing life.

Dr. Freireich was born in poverty in Chicago, and he struggled, but he ultimately ended up in medical school. He was a visionary person and also a person who always thinks outside the box and always thinks very unconventionally.

So, when he moved to the NIH he had many difficulties with the leadership because he was coming up with ideas that were not in line with the traditional thinking. So, his first thought was that platelets, if we isolate them and give them to patients with leukemia who were dying from bleeding complications, could help that. So, he had to demonstrate this, giving fresh blood to patients with leukemia and low platelet counts.

And when he showed in a randomized trial, actually, of fresh blood versus stored blood, that the fresh blood containing the effective platelets which are stopping the bleeding—people did not believe him. They thought that he was lying.

Then he moved on to develop what we now call the apheresis machine. He partnered with IBM to create the machines that separate the platelets from the red cells, from the white cells. And this is how he started the research on platelet transfusions, and this is how the apheresis machines that we have today were the product of his imagination.

Now every hospital has apheresis machines that separates platelets, gives them to patients, and separates the blood components. And also the apheresis machines are used today to collect stem cells for the purpose of peripheral stem cell transplantation.

The other big innovation was his use of combination chemotherapy. So, in those days, in childhood ALL, there were four chemotherapy drugs developed over two decades that were of use. One was prednisone or steroids, then 6-mercaptopurine and methotrexate and vincristine.

Dr. Freireich had the audacity to say, rather than giving them each as a single treatment, we should combine them together. You have to remember, in those days, doctors, when they encountered the child with leukemia, they said, “Let’s not let them suffer. Let’s let them die peacefully and with dignity.”

So, when Freireich started treating patients with childhood ALL, this was heretic. And once he started doing those therapies and moved to the combination, people thought that this was crazy and that he was a criminal, because why should you waste all your important bullets, and at one time, rather than sequence them to prolong the survival?

So, this was, in those days, a highly controversial and innovative idea, and this is how he showed that childhood ALL could be cured.

This was the second cancer that could be cured. The first one was choriocarcinomas using methotrexate. But the second cancer that was highly curable was the result of Dr. Freireich’s efforts of combination chemotherapy in childhood ALL.

HK: When I came in 1981, I had changed a little bit from, because of my experience in 1978. So, I started thinking that really creation of knowledge is more important than absorption of knowledge. And I watched Dr. Freireich during my fellowship.

Dr. Freireich was a very outspoken person, and he moved things and made progress sometimes through confrontation. And it wasn’t a real confrontation. He just wanted you to think about things and see if you can find alternative ways to the traditional approach. So, this was his way of challenging people to think differently and to change their minds.

So, this was the first and most important lesson I learned from Freireich, which is not to accept knowledge as it exists, because it is true that probably 95% of the knowledge that exists today will become obsolete 10 to 20 years from now. So, it’s very important to continue to challenge the standards, the accepted standards, and to try to create new knowledge and innovate outside the general herd mentality that exists at any point in time.

HK: No, I think in 1978 and in 1981, most of the leukemias were incurable. So, we divide them into the chronic leukemias: Chronic myeloid and chronic lymphocytic leukemia. In those days, the average survival in these two chronic leukemias was two to three years and we had very few treatments like busulfan in chronic myeloid leukemia and some steroids—cyclophosphamide and chlorambucil in chronic lymphocytic leukemia.

Today, chronic myeloid leukemia is highly curable with the Bcr-Abl kinase inhibitors functionally and molecularly. And patients with CML live their normal life. So, now the estimated 10-year survival has increased from 10-20% before 2000 to over 90% in 2023.

In chronic lymphocytic leukemia, a similar situation happened more recently, where the discovery of the efficacy of the Bruton’s tyrosine kinase inhibitors and Venetoclax as single agents each led the MD Anderson group and many others to combine these two drugs in a fixed duration of therapy.

And now, even though chronic lymphocytic leukemia is still quoted as being incurable in the cancer and medical textbooks, I think we have the tools to cure chronic lymphocytic leukemia.

So, with this combination, now we’re demonstrating that the disease disappears in most patients with CLL and the estimated four to five year survival is over 90-95%, and patients are stopping therapy and the disease is not coming back.

So, I think chronic lymphocytic leukemia is curable.

With the two acute leukemias, ALL and AML: In 1981, the cure rate with intensive chemotherapy was around 20 to 30%. Today, ALL has estimated five year survival rates over 80%, and AML and its subset has estimated five year survival rates in the range of 50 to 80%.

HK: So, first, it is not my list of accomplishments, because the accomplishments are so many that it is impossible for these to be accomplished by an individual. The accomplishments are the results of a very large group of leukemia experts that have been at MD Anderson since 1965.

Freireich came to MD Anderson in 1965, he established the Department of Developmental Therapeutics, which was one of the first and largest departments solely dedicated to cancer research. Then in 1979, the Department of Developmental Therapeutics split into about 12 or 14 specialty departments. One of them was leukemia. And in 1981, when I came to MD Anderson, the Leukemia Department had about seven leukemia experts, Dr. Freireich, McCredie, Keating, Ron Walters, and a few others. Now, today, the department has about 40 to 50 leukemia experts, and most of them stay at MD Anderson and continue to do leukemia research.

And this is why—because we have a large body of highly trained people in a very rare leukemia, and because we inherited the mentality given to us by the first generation of Freireich, McCredie, Keating, and others—we were able to do so much research and to innovate and publish on it.

The progress is the product of many, many leukemia experts at MD Anderson, as well as leukemia experts in the United States and in the world.

But I’m very proud of the research that we have done here. If I had to cite the two accomplishments which I’m most proud of, I would say that these are accomplishments of resuscitating drugs that were ignored or discarded.

One of them was decitabine that we developed uniquely on an investigator IND in 1992 at MD Anderson. And it ended up being one of the two most important hypomethylating agents, which are FDA approved and used in myelodysplastic syndrome and acute myeloid leukemia.

The other big discovery happened more recently with the development of antibodies against targets in acute lymphocytic leukemia.

The two drugs I’m very proud of—because they were the product of a lot of our research—are inotuzumab, which targets CD22 in ALL and blinatumomab, which targets CD19 in ALL. So, we started using combinations of these two antibodies with the chemotherapy, and we’re having fantastic results. So, these are some of the recent discoveries that our group is very proud of.

HK: No, actually, there’s a lot of pushback. Anytime you are not in line with the traditional thinking, there are people who may get annoyed or be suspicious of the research. So, if you think about cancer research and research in general, there are 1% of the experts who are innovators, and they are almost always highly controversial, because when they start in their research, people disbelieve it and sometimes this leads to heightened emotions and so on. So, there’s always some form of a conflict when you’re thinking outside the group mentality. And 99% of the people are generally comfortable with the existing knowledge.

They may be watching you on the side, and until what you are proposing is proven, there’s a lot of distrust and disbelief in what people do. So, anytime you try to innovate in any field of medicine or outside of medicine, there’s going to be a large group of experts or people who deal with the same issues that do not believe you and may have serious doubts about the research.

HK: I think decitabine is one of them, because decitabine seemed to many people like a “me too” drug, like cytarabine. So, decitabine was developed as a cytotoxic drug in the 1980s in Europe, and it was found to be very toxic at the dosages that were used, which were two grams per meter squared.

So, in 1992, I was at a meeting in Rome, and I happened to be in a symposium where decitabine was discovered. And I thought that perhaps this is a drug that was ignored—because it had been abandoned in Europe—and there was not much research with decitabine in the United States.

In 1992, I worked with a company in Europe, PharmaChemie BV that had the drug, and they allowed me to develop what’s called an IND protocol, which is an investigator study where we imported the drug to MD Anderson in 1992, and we started the research.

But we started using it as a hypomethylating agent rather than a cytotoxic agent. So, we started using the dosages at one in 20. So instead of two grams per meter squared, we started using the drug at a hundred milligrams per meter, per course.

And this was with the help of Dr. Jean-Pierre Issa, who is a wonderful expert in epigenetic therapy and hypomethylating agents, and who had joined the leukemia group at MD Anderson.

From 1992 till 2002, we were the only group in the whole of the United States and the world who are still doing research with the decitabine. We repurposed it as epigenetic therapy, and then we developed the phase III trials that led to the approval of the drug in the United States as a treatment for myelodysplastic syndromes, and later in Europe for the treatment of older unfit AML.

So, I think decitabine was probably one of the most difficult drugs to develop because the standard notion was, “It’s similar to cytarabine, so why do we need to reinvestigate it?”

Inotuzumab had a similar tract, because inotuzumab, the drug for ALL, the company that had it, Pfizer, was developing it for lymphoma in a phase III trial. And again, MD Anderson took an investigator IND, and we started developing it in ALL, but there was no support except for the free drug.

When the phase III in lymphoma of inotuzumab failed, we had treated already 90 patients with ALL with that single agent, and found it’s probably more effective than intensive chemotherapy. So, then we went back and developed the phase III trial led by MD Anderson, that led to the FDA approval of the drug in acute lymphocytic leukemia.

These are two drugs that are of interest, because they had been somewhat abandoned by either the drug companies or the leukemia investigators. And through efforts at MD Anderson, we were able to resuscitate them and get them to FDA approvals for different indications.

HK: Let me walk you through the history of this. Cancer drugs were not always that expensive. They started becoming expensive with the development of novel targeted therapies. So, in 2000, when Brian Druker developed imatinib for chronic myeloid leukemia, the drug came to the market at the price of $32,000 a year, which was the equivalent of the price of interferon, which was the standard competitor. And, you know, leukemia doctors, cancer doctors, and physicians in general do not pay attention to the price of drugs.

So, I was shocked in 2012 when I realized that the price of imatinib and, for that matter, many of the targeted therapies, was not only expensive at the start, but had quadrupled to over $100,000 a year, even though the company had made all its profits, even though the population under treatment expanded.

So, there were more profits, yet the choice was to continue to increase the price of the drugs. And that has been a trend throughout the years where drug companies increase the price of patented drugs by 10-12% a year.

They also delay the expiration of patents. So, patents are supposed to last for eight to 12 years, but through different maneuvers in the United States, you can extend the patent, through subfilings and so on, to 15, 20, or even 30 years, sometimes more.

Importantly, it seems to be that even when the drugs become generic—and you would expect that the price of the drugs will go down very quickly—that doesn’t seem to be the case, because of the intermediaries that exist between the drug company, where the drug goes out, to the patients.

These intermediaries continue to increase the drug prices. So, let’s take imatinib now, where there’s a patent expiration for many, many years. There are 15 generic imatinib [drugs], and they all get out of the drug manufacturer at an average price of $5,000 a year.

But when they reach the hands of the patients, 13 of the 15 have a price of $130,000 because of the profits through the intermediaries.

So, the problem in the United States is that healthcare is for profit and there are market forces that distort the competition and lead to the expensive drugs, because everyone wants to make some profit. This is not the case outside of the United States, in Europe, in Canada, in the Middle East, and many other areas where actually the same drugs—which were developed in the United States, through American taxes—people outside of the United States get access to these drugs, sometimes at a fraction of the price of the drugs in the United States.

So, in 2012, myself and many others started highlighting this problem. And the problem exists truly because even though we think that the healthcare system in the United States is the best in the world, this is not the case. Even though we spend 18% of our GDP on healthcare, countries in Europe spend 6-9%, and yet with objective measures, they deliver better care to their patients.

I just did an analysis on the through the SEER data on survival and chronic myeloid leukemia in, in Sweden, in Europe, where there is universal healthcare and all patients with CML get access to regular imatinib and TKIs, the 10-year survival is 90%. In the United States, the SEER data shows that the 10-year survival in CML is still about 60-70%.

There are at least 20-30% of Americans who are not getting optimal treatment in chronic myeloid leukemia, simply because they cannot afford the price of the drugs.

Of course, the drug industry tries to say, “Well, this may not be true, and if you curtail the drug prices, you curtail in innovation,” but this is actually not true, and I and many others have written editorials to the effect that if you reduce the drug prices, innovation will continue in the United States.

I think, despite a decade of advocacy, things are going to start to happen.

For example, very recently, Mark Cuban, who’s a billionaire, decided to create a generic drug company where they will sell the drug at cost plus 15%. So, if the same trend continues, and there are several innovators who are developing such outlets that bypass the intermediaries, then we will be able to see a significant reduction in the cost of generic drugs.

So, I’m optimistic that there are going to be new tools and innovations in cancer care and in medical healthcare where drug prices are going to be significantly lowered through such interventions and innovations.

HK: In oncology, I think we are on a wonderful positive track where there are many new discoveries—targeted therapies, immune modalities—which are adding to the therapeutic armamentarium.

I’m very impressed, for example, with the data with immune therapy through the efforts of Nobel Prize winner, Dr. Jim Allison, where those checkpoint inhibitors are curing about 50% of patients with melanoma. You have to think that melanoma was one of the most incurable cancers. And today, it is one of the highly curable cancers.

This was the first and most important lesson I learned from Freireich, which is not to accept knowledge as it exists, because it is true that probably 95% of the knowledge that exists today will become obsolete 10 to 20 years from now.

We have not only surgery, radiation therapy, chemotherapy, targeted therapy, but now also the immune therapies which come in the forms of antibodies, or CAR T cell, or checkpoint inhibitors, and perhaps in the future, NK cellular therapies and others. So, I am very, very positive about the progress in research in cancer.

I think cancer will be history in the next 20 years, throughout most of the cancers, if not all of the cancers.

I’m not concerned about this.

What I’m concerned about is the healthcare inequities. I would like to see in the United States a form of universal cancer and health care that allows not only the rich to be cured, but also the poor to be cured, equally and effectively.

I’m concerned about healthcare and cancer care in the United States being unequal, and I would like to see procedures and legislations that equalize the opportunities of cure in cancer and in medicine in general.

It should not be the case that a person who has a good insurance or who is rich could come to MD Anderson and have access to the most innovative research with the most effective drugs—and many of those drugs will be for free on a protocol—when, on the other hand, there would be a poor person who has the same leukemia that could be highly curable and cannot access this kind of research or care because they do not have a good insurance or they do not have access to this kind of healthcare.

I’m most concerned in cancer care about legislation and strategies that equalize cancer care across Americans to allow the poor and the rich to have an equal opportunity at the cure.

HK: MD Anderson is the number one cancer center because we did focus on clinical translational research, and we focused on delivering the most optimal, exceptional cancer care through research. So, research driven, exceptional cancer care.

My advice to the young people and to people who do clinical translational research is to keep being optimistic, to advocate for their patients, and to continue to innovate and think differently than the standard thinking.

I think innovation is the only way where we can transform knowledge over time, and we have to continue to do the research, both in the lab and in the clinic, and translate the discoveries from the lab to the clinic and vice versa in the shortest period of time possible.