Interview: Dr Larry Kwak, cancer-research scientist and physician

09 February 2018

‘More scientists are coming to the conclusion that science can actually support faith’

City of Hope is one of fewer than 60 academic medical centres in the USA designated as comprehensive cancer centres by the National Cancer Institute. We combine research and clinical facilities for the diagnosis and state-of-the-art treatment of cancer patients.

 

My primary responsibility is to shape the next generation of research and treatments for cancer. As vice-president and associate director for translational research and developmental therapeutics, I combine the roles of a physician, scientist, and mentor. My vision is to assemble and lead research teams to accelerate the translation of basic discoveries from laboratories to clinical development and first-in-human clinical trials of novel “home-grown” therapeutics, such as next-generation cancer immunotherapies.

 

City of Hope has a unique culture of research-driven patient care. Our research is approved and regulated by the FDA [US Food and Drug Administration], but what’s unique is the infrastructure for taking laboratory discoveries to first-in-human clinical trials, where research can have most impact for patients.

 

We have three clinical-grade manufacturing facilities to make new drugs on our campus. This function is normally done by pharmaceutical companies, which can complicate and lengthen the process of testing new agents. We don’t have that obstacle here at City of Hope.

 

I had a pivotal experience during a summer high-school internship. I was doing some menial tasks in a hospital clinical laboratory — but afterwards, every day for about an hour, my mentor, a pathologist, would invite me into his office and show me slides, under the microscope, of cancer cells. Interspersed with those cancer cells were normal immune cells. He would challenge me to think about why those cells — the normal immune cells — were there, and could they one day be harnessed to fight cancer?

 

From that point on, my education and training were aimed towards that ultimate goal of being able to make discoveries in the laboratory as a scientist — and then, as a physician, to be able to walk over to the clinic and offer those cutting-edge treatments to patients.

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I was honoured by Time magazine for my 20-year commitment to the science of cancer vaccines. I think a major component of any recognition is the right timing. I was very fortunate to be involved in the beginning of cancer immunotherapy research, and so I was one of those whose research set the groundwork for the successes that we’re seeing today in the clinic. We now have treatments which are actually approved by the FDA in this field, and it’s opened up a whole new area, Immuno-Oncology, which is very promising. In particular, there is excitement about a new class of cancer vaccines that is re-emerging as a cutting-edge approach.

 

A cancer vaccine works the same way conventional vaccines work against diseases such as polio, smallpox, and tetanus. For example, the tetanus vaccine contains one protein specifically made from the tetanus bacteria: when injected, it activates the immune system; so it’s primed and ready to eliminate the bacteria if an individual is infected. In the same way, a vaccine against cancer consists of a protein studding the surface of the cancer cell. When injected, it activates the immune system to recognise the protein on the cancer cell and fight it.

 

It’s a specific treatment for patients who are suffering from cancer, not a preventative measure. It’s too early to say that cancer vaccines can cure. Although several have shown enormous promise in late-stage clinical trials, their full potential is still unknown.

 

I remember searching in high school, wondering if there was a God. Our family attended church only a couple times a year — usually at Easter and Christmas. I explored the Bible, although it didn’t make a lot of sense at the time. When I was a freshman in college, a friend shared the essence of the Christian message with me, and, while it wasn’t an earth-shattering experience, it addressed a lot of my questions.

 

In my work, I also observed the multiple redundancies in cytokine networks in immune cells acting as safeguards, and view these as hallmarks of something that was likely created rather than arising by chance.

 

More scientists are coming to the conclusion that science can actually support faith. Francis Collins, the director of the National Institutes of Health in Washington, DC, has written a bestselling book, The Language of God, in which he shares his observations of the intricacies of the genetic code as he led the Human Genome Project, which mapped all 25,000 genes that make up the genetic material of humankind.

 

We all have a universal calling to serve others, and I feel enormously privileged that my specific God-given calling in life is also my occupation. I wake up every morning excited to go to work, because I think it could be another day when we make a discovery that could impact patients.

 

One example of when I saw God’s intervention in my work was 20 years ago, when my very first patient was so ill that, if we did not give her the cancer vaccine within a few months, she would be too sick to receive it. This vaccine, however, had only ever been tested on our laboratory animals up until this point, and we were a few years away from offering it to human subjects. So we had to go through quite a few hurdles to get this vaccine approved by the FDA for use on a person for the first time. Permission was received on a Friday, and the following Monday was the cut-off date for when we would no longer be able to administer the vaccine. I believe it was God’s hand that really moved things forward at this critical time.

 

A lot of things in this world don’t make sense, including people dying young. C. S. Lewis tackles this in The Problem of Pain. God never promised that life would be fair, just, or perfect. That’s what we look forward to as we exit from this earth some day. But I believe God’s presence is everywhere in many who combat injustices, sufferings, and evil in this world.

 

My own faith in God enables me to stay focused on making urgent, innovative discoveries that will impact patients; and his presence and comfort, to those who experience them at the hour of need, are what enable people to survive incredible circumstances that just don’t make sense.

 

There’s never an easy way to inform someone of a cancer diagnosis, but I always instil hope. I explain the facts, but I balance that information with the hope that there are so many new treatments in development; and I share with people the importance of a family or other support network.

 

My parents immigrated to the USA from South Korea as students: my mother for undergraduate studies in music and biology, and my father for his Ph.D. in physics. I grew up predominantly in Lawrence, where my father was a professor at the University of Kansas. I have one sibling, Sarah, who’s a professional violinist.

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My wife, Ruth, is the greatest influence on my life. She has constantly reminded me that my career is not my own, especially when I encountered obstacles in my research. She’s been my greatest cheerleader. There were many points throughout my career when I felt that the challenges were overcome not by luck or coincidence, but as a direct result of her prayers.

 

Ruth and I authored a book in Korea on teamwork in parenting. I made intentional choices to be involved in the lives of my four children. I still recall turning off my mobile phone as soon as I arrived home when our children were young, to give them my undivided attention until they went to bed. Now, we enjoy serving a charity, travelling, and giving talks to couples with young families. It’s possible to live out your calling and be committed to family life.

 

I pray the prayer of Jabez in 1 Chronicles 4.10: that God would bless us by enlarging our sphere of influence among patients, mentees, and young families. Contemporary praise-music energises and inspires me.

 

A member of my team slacking makes me angry, because this can adversely affect the overall success; but it makes me happy when they launch their own successful careers.

 

I always hope, because good outweighs the bad in the world, despite what we see in the media daily. Our God-given hope cannot be taken away.

 

I’d choose to be locked in a church with the biblical Joseph. I admire his perseverance, faith, and the excellence he exhibited in his craft.

 

Dr Kwak was talking to Terence Handley MacMath. He was speaking in a personal capacity.

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