1. Neff Newitt, Valerie

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Vikas Dudeja, MBBS, tenured Assistant Professor of Surgery in the Division of Surgical Oncology at Sylvester Comprehensive Cancer Center, University of Miami, has come a long way-both geographically and professionally-from his native home of Hardwar, next to the bank of the Ganges River, in northern India.

Vikas Dudeja, MBBS. ... - Click to enlarge in new windowVikas Dudeja, MBBS. When not in the lab or clinic, Vikas Dudeja devotes free time to his family, including his children, from left, Vivaan, 8, and Vanya, 7.

The former boy with an inner desire to pursue medicine has grown into an esteemed researcher seeking insights into pancreatic cancer-why it is so aggressive and what can be done to treat it more effectively.


While some in a similar position are eager to start a conversation about their professional progress, Dudeja took a very different route during a recent interview with Oncology Times.


"Maybe you should interview my wife, because she knows more about me than I do," he said off the cuff. "In fact, when you write about my life, please say that I owe a lot of my career and my progress to my wife, Charu. She has sacrificed her own career for me. It is true. And honestly, I have no idea how much money I make, no idea how much we pay for our mortgage, no idea how much the electric bill is," he added with a chuckle. "She is the one who keeps my life on track."


The result of a "love marriage"-not a more traditional arranged marriage common in India-the couple first met in high school. They came to this country together and now are proud parents to their son Vivaan, 8, and daughter, Vanya, 7.


Describing himself as a somewhat cautious boy, he avoided activities like karate and cricket, "... because you could get hurt." Asked what he did for fun, he laughed and admitted, "Badminton. That's what I did." Thinking back to the days before his career took flight, Dudeja said he grew up in a town inhabited completely by "engineers, engineers, engineers-nothing but engineers," including his father, all of whom worked for Bharat Heavy Electricals Ltd.


"My father wanted me to be an engineer and would take me to work with him to see the big machines. He saved all of his engineering books for me. After all, no one in our family was ever a doctor. I had one sister who grew up and went into the business side of fashion design, so I was his only hope."


But fate, and free will, interceded. "I don't know when it came to me .... I just wanted to be a doctor. Biology always was connected to me and directed me toward medicine. In India, students go right after high school to medical school. They must make up their mind and make that big decision.


"When I entered medical school I found out it was hard, of course. But I am the type of person that once I start something I feel I must carry it to the end and complete it. That helped me. And my father? He was very supportive and just wanted me to do my very best."


Coming to America

In India, Dudeja saw a lot of patients with cancer who were not doing very well. "I realized the only way to improve their outcomes is through research and finding better cures," he said definitively. "After I had graduated and received my medical degree and initial surgical training from All India Institute of Medical Sciences in New Delhi, I wanted to learn more about cancer. Research and even surgical treatment are much more advanced in the U.S. than in India, so I decided to leave home."


Naturally, arriving stateside required an adjustment period. "It was very interesting. There is a culture shock because at first we were not used to the way things are done here-even little things. For example, here you order a sandwich and you can say with lettuce, no tomatoes, add peppers, no olives, and a little bit of mustard, all on wheat bread. Americans take these options for granted. But for someone coming from India it presents a struggle every day. India you order a sandwich and that's it. There are not a hundred options. You order and you are done."


Punctuating the example with laughter, Dudeja then added solemnly, "We were welcomed into this country with open arms. It was an amazing, life-changing experience. Although it seemed really different, it was a great blessing to come here. I have grown so much in research and grown so much in my clinical arena."


Dudeja completed a research fellowship in the lab of his mentor, Ashok Saluja, PhD, at Sylvester Comprehensive Cancer Center. He went on to complete his general surgery residency at the University of Minnesota and completed a fellowship in Complex Surgical Oncology and Hepato-Pancreato-Biliary Surgery at Memorial Sloan Kettering Cancer Center. He assumed a faculty position at the University of Minnesota as an Assistant Professor, Masonic Cancer Center Scholar, and Varco Surgeon Scientist until he was recruited to the University of Miami.


"Dr. Saluja works on the pancreas, so I started working on pancreatic cancer, even though I did not have much exposure to pancreatic surgery in India. He has been a strong influence," said Dudeja, who now divides his professional time evenly between the clinic where he surgically cares for patients with liver, pancreatic, and biliary cancers, and his research lab.


"I have an amazing life," he reflected. "Many people who do research, but not clinical work, never get to see the patients who will benefit or not benefit from their research. They know that the numbers and the statistics for pancreatic cancer, liver cancer, and metastases are very, very bad. But they are never able to put a face onto those numbers.


"That is both the beautiful and sad part of my job. Dealing with patients every day in the clinic, I see that we need to change things, and that we need to change things quickly," Dudeja said. "As such, my life is much more blessed than those clinicians who only have clinical responsibility; they are seeing these patients but they are not able to change anything. In the clinic I see patients-their difficult plight-and it gives me a sense of urgency when I come to the lab."


Seeking Solutions

Dudeja drove home an important point. "There is no such thing as 'early disease' in pancreatic cancer. When patients with pancreatic cancer come, and their tumor is localized and only in the pancreas, I cut it out. Then they ask, 'Doctor, did we catch it early enough to cure it?' And I have to tell them that even though this ugly pancreatic tumor was removed, there is a 95 percent chance it is going to come back.


"When you take care of patients in clinic, you realize that no tumor in the pancreas is an early tumor. Even an 'early' pancreatic tumor is an aggressive disease which has already spread; we just can't see it. By the time we find a pancreatic tumor, it is already late."


These are the kinds of things Dudeja and his team are trying to address and grapple with in the lab. "We are trying to find ways by which we can make chemotherapy effective against pancreatic cancer. We are trying to find out what helps pancreatic cancer cells survive or become so aggressive. We have found out that a protein, HSP70, is overexpressed in pancreatic cancer and helps tumors survive harsh conditions, thus allowing it to become more aggressive," he explained.


Working in mouse models, the team has developed a drug, Minnelide (derived from a compound, triptolide, found in plants), based on the concept of suppressing HSP70 expression. It is now in a phase I/II clinical trial.


Dudeja's lab is not only focusing on the cancer cell. "We are also focusing on its environment. Recent studies suggest that immune cells and fibroblasts in the environment of cancer help it grow and metastasize," he noted. "Our research shows that by affecting or modulating these immune and fibroblast-like cells, we can decrease tumor growth and make many therapies more effective. We are right now identifying chemicals and molecules secreted by cells in the cancer environment which help them grow, and we are trying to develop drugs which decrease these harmful chemicals."


Dudeja said one of the most interesting recent findings from his lab is that certain bacteria in the intestines support tumor growth. "Modulating these bacteria, for example by antibiotics, can decrease tumor growth," he detailed. "It seems like there is a vicious cycle in which cancer helps certain bacteria to thrive in the gut, and then those bacteria in turn support tumor growth. The bacterial composition of our intestines may hold the key to the increased incidence of various cancers seen in current times as well to understanding the effect of diet on cancer.


"Right now we are trying to find out why cancer promotes certain bacteria and why certain bacteria promote cancer and exactly how they do it. One way to do that is to address and explore the bacteria byproducts."


Dudeja's team is hard at work trying to identify bad bacteria, validate those findings in humans, and find antibiotics which can affect those bacteria. "Because we know that antibiotics are safe, we hope we can actually translate these findings into clinical use quickly," added Dudeja. "Further, if we can pinpoint those bad groups of bacteria, we can even find out what foods support those bacteria. That will help us define a beneficial or harmful diet."


The Goals at Hand

As he considered his career goals, Dudeja said in the short-term he hopes to bring the findings that emerge in his lab to the clinic. But the overarching long-term goal is found in understanding processes better, so that he and others can take the best therapy to the patient. He stressed that it is not only important to translate findings to clinical care, but to continue to build on those findings so that they continually translate better across time.


Ultimately, Dudeja hopes to change the depressing numbers that pertain to pancreatic cancer. "Right now a patient with localized disease of the pancreas still has only a 20 percent chance of being alive at 5 years. This is in contrast with other cancers. If, in my lifetime, we can get those numbers to 30-40 percent for 5-year survival for all pancreatic cancers, that would be significant."


If given a chance to speak directly to fellow oncologists who encounter aggressive cancers, Dudeja said he would offer the following advice. "First, reject nihilism. Avoid thinking that, because outcomes are so bad, why not send patients home to enjoy remaining time and then just die. I think that is wrong.


"Tell patients that things are bad, but things are getting better because things really are getting better. Even though our treatments are not yet the best, we are helping patients live longer," he stressed. "And that matters."


Second, Dudeja said he hopes other clinicians will encourage patients to participate in clinical trials. "If we don't have patients in trials, we cannot do research, we cannot find out what the best treatments are. We may not be able to help patients enough right now, but without clinical trials we will not be able to help patients ever."


He also urged that clinicians take to heart the value of sending patients to high-volume centers. "If surgeries for these cancers are done at places which do them day in and day out, the outcomes are much better," Dudeja advised.


Finally, he wanted to underscore the importance of grassroots movements in the support and funding of cancer research. "It is very important; we must all remember that."


In a final pivot back to his personal life, Dudeja admitted that he tends to be a workaholic. So he devotes his limited time away from clinic and lab to his family. "I like to do things with my kids," he said. "I try to spend time with them to compensate for being so busy with work. And then, if there is any time left, I love to watch action movies. There's one, Spy Game, with Robert Redford and Brad Pitt that is really awesome."


And Indian Bollywood movies? "They are not for me," he said, assertively. "Just when you start liking the movie plot, and it's time for something important to happen, there's a big dance sequence! Right when you are waiting for the next big thing to happen, they start dancing. You have to think, 'Oh, c'mon. Are you kidding me?'"


Though he may eschew Indian movies, Dudeja makes it a point to go back to his homeland almost every year. "I miss family, I miss the food. When we go for 7 days, every one of them is a treat. Even though the country is crowded, and the cities polluted, it is an amazing treat to be surrounded by the scents I grew up with, the food, the sounds. I love it. I miss it. It still feels like home."


Valerie Neff Newitt is a contributing writer.


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