Team Spirit Guides Gandara in Personalizing Care

David R. Gandara, MD

Each morning, David R. Gandara, MD, wakes up energized to spend another day as an oncologist in lung cancer practice and research, a field in which advances have been more rapid than anything previously seen in oncology.

As the director of the Thoracic Oncology Program at the University of California, Davis (UC Davis) Comprehensive Cancer Center in Sacramento, he knows all too well about how quickly life can change when someone is presented with a diagnosis of lung cancer. Lung cancer kills more than 155,000 people each year in the United States. But with dedicated experts, such as Gandara, lung cancer treatment is improving as new treatment options are developed.

The Road to Oncology

Growing up in Tyler, Texas—a town 100 miles east of Dallas—Gandara realized early on that his dual calling was in medicine and in writing. His current academic position at UC Davis gives him the opportunity to use his communication skills to the fullest. “I thought medicine would be a good way to be able to do that. I always envisioned myself being in academic medicine, where teaching is an integral part of what I do.”Gandara earned his undergraduate degree from The University of Texas at Austin and went on to attend medical school at The University of Texas Medical Branch in Galveston, where he graduated with honors. At night, he worked as an emergency crossmatching technician for blood transfusions.

After medical school, Gandara headed west for his residency, which he completed at Madigan Army Medical Center in Tacoma, Washington. This was where he latched onto the field of oncology and began his training in hematologyoncology in San Francisco at Letterman Army Medical Center.

“Every rotation in medical school that I went through, I enjoyed, and I thought, ‘Well, I’m going to be an orthopedic surgeon or I’m going to be a psychiatrist,’” he recalled. But in his residency he had the opportunity to work with oncologists. “I felt, ‘Here’s a big need and an area that is likely to really expand and take off within my career time,’ which it has. I think it was a very good choice for me.”

Gandara has spent most of his career at UC Davis, where he served as associate director of clinical research for 20 years. During his career, he has also chaired the Southwest Oncology Group (SWOG) Lung Cancer Committee, which he acknowledges gave him many opportunities to work with other leaders in the field, as well as people at the National Cancer Institute (NCI).

In his development as an oncologist he made an effort to associate with experts who could provide mentorship through their deep insight. “I have been fortunate enough to be surrounded by very bright, collaborative people who have worked with me and are responsible for many of my achievements,” he said.

The biggest change in Gandara’s career came after his appointment as chair of the SWOG Lung Cancer Committee. “It allowed me to express myself,” he said. “I was relatively junior when that happened, and it allowed me to, over a period of 15 years, grow my own career and mentor a lot of other people and be associated with many important projects in lung cancer.” Gandara is multiskilled and finds himself wearing many hats. He spends his time teaching, conducting clinical research, designing clinical trials, doing administrative work, and seeing patients. “I take care of all the components of an academic career,” Gandara said.His research is focused on the development of new anticancer agents, preclinical modeling, and clinical research, aided by Gandara’s leadership of multidisciplinary teams. His recent work includes phase I molecular and clinical pharmacology trials, early therapeutics trials with phase II emphasis, and discovery and identification of blood biomarkers for early detection of lung cancer. In addition, Gandara has been instrumental in teaching others about multimodality therapy, such as how to integrate radiation with chemotherapy and surgery.

Personalizing Care

He is also one of the chief architects of the Lung-MAP clinical trial, a collaborative effort that uses multidrug, targeted screening to match patients who have advanced stage squamous cell lung cancer with trials of investigational new treatments. Lung-MAP is recruiting patients across the country at cancer centers, community hospitals, academic medical centers, and physician cooperatives. It is the first large-scale precision medicine trial launched with support from the NCI. “This is an entirely new way of looking at the development of cancer drugs,” Gandara said. “This is no longer business as usual. This approach changes the paradigm.”Around the office, Gandara sticks with the motto: Find the right treatment, for the right patient, at the right time. His career ambition is to continue to find ways to personalize cancer care, so that “each patient is treated as an individual,” he said.

One way in which he is working to further personalize lung cancer treatment is on a Stand Up to Cancer (SU2C) project that combines drug therapies with immunotherapy to improve outcomes. Gandara serves as principal investigator at UC Davis on the SU2C Dream Team project, which targets mutations in the KRAS gene, which are found in 20% to 25% of patients with lung cancer. Under Gandara’s leadership, UC Davis is contributing preclinical modeling of new treatments using a patient-derived xenograft resource.

According to the project’s website, “The team has devised a 3-pronged approach to create new treatments for patients with KRAS-mutant lung cancers. First, the researchers will identify the most effective therapies for targeting KRAS and other related biological pathways. Second, they will develop approaches to exploit the immune system for the treatment of KRAS-mutant lung cancers. Third, they will integrate targeted therapies with immunotherapies as a novel combined approach to treatment of KRAS-mutant lung cancer.”

Gandara explained that the patients with lung cancer whom he treats regularly are unique. “In northern California, the prevalence of smoking is much less—about 10% of the population,” he said. “My average patient with lung cancer is a woman, not a man. The average age is about 45 or 50, not 70. And about 40% of my patients have never smoked. These are not the typical faces of lung cancer that you read about. It’s a very different sort of population.”

Across the spectrum, there are many advances being made in the cancer arena. In particular, lung cancer treatment is improving thanks to immunotherapies and targeted therapies for specific mutations.

“Never in the field of oncology have there been so many advances within a short period of time as there have been in lung cancer treatment over the last couple of years,” Gandara said. “Where that is headed is very unclear, and there are regulatory and political components that are beyond the control of investigators, so it has become much more complex to speculate on how things will unfold.” However, Gandara expects that these treatment options will become more and more complex and that patients will continue to play a greater role in determining what therapies they receive.

Gandara has also worked to bring together diverse groups of experts to solve problems in cancer. He calls this “team science.”

A Giant Leap

“This is where the achievements of the team as a whole exceed that of any of the individuals, and that is my career,” he said. Although this paradigm has been present for many years, the idea went mainstream with the launch of former Vice President Joe Biden’s Cancer Moonshot program. “More and more, in the last few years, this concept of team science has been recognized as incredibly important—that when you put a lot of smart people together, you get more out of it than you would from any of the individuals by themselves,” Gandara said.If he had never become an oncologist, Gandara believes, he could have fit the role of a teacher or a writer. “I think I have a knack for communicating. I specialized in developing some methods for facilitating communication between patients and their physicians,” he said.

However, his passion is helping advance the field of oncology; and his role as an oncologist and his innovative research have earned him a place among the Giants of Cancer Care® award winners.

“The prior recipients are all world-class oncologists and hematologists. To be included among them is a privilege,” Gandara said.

Although he loves fulfilling the demanding duties of an oncologist, he does enjoy his downtime. When he’s not in the hospital, you can find him on the water, preferably in his kayak, catching fish.

“I like to fish. I think it’s a great stress reliever,” Gandara said.

To close, Gandara shared his favorite life quote: “Live every day to the fullest. Take advantage of the time that you have.”