Robert Gatenby Moffitt Cancer Center

Season 2, Episode 2 Robert Gatenby Moffitt Cancer Center

Welcome to Shaping Our Story with host Louise Krikorian—where inspiring leaders share their passion, purpose, and perseverance to help you thrive.

In this episode, we sit down with Dr. Robert Gatenby, Chair of Diagnostic Imaging at Moffitt Cancer Center and a pioneer in evolutionary oncology. As the founder of the first Cancer Biology and Evolution Program in the U.S., Dr. Gatenby is redefining how we understand cancer through Integrated Mathematical Oncology, game theory, and adaptive therapy.

🔬 What You’ll Learn:

• Why cancer evolves and becomes resistant to treatment
• How mathematical modeling is transforming precision cancer care
• The role of adaptive therapy in managing cancer long-term
• Why cancer may be treated as a chronic disease—not just cured
• The power of perseverance in groundbreaking scientific discovery

Dr. Gatenby shares his journey from traditional radiology to challenging decades of conventional cancer treatment—and why thinking differently could save lives.

💡 If you’re interested in cancer research, medical innovation, oncology breakthroughs, or the mindset behind true innovation, this episode is a must-watch.

👉 Connect & Learn More:

Email: robert.gatenby@moffitt.org
Follow Moffitt Cancer Center: moffitt.org

https://www.moffitt.org/inspiring-stories/dr.-gatenbys-story

Optimize Cancer Therapy Using Evolution | Michael Levin & Robert Gatenby

and Aastha Jain  https://youtu.be/NiyNfxU2C1o

Progress, Potential and Possibilities Ira S. Pastor & Robert Gatenby

https://youtu.be/B7G8hmVdBpA

👍 Enjoyed this episode?
 Like, comment, and subscribe for more conversations that inspire growth through passion, purpose, and perseverance.

#CancerResearch #Oncology #MedicalInnovation #PrecisionMedicine #AdaptiveTherapy #Podcast #ShapingOurStory

Information

Louise Krikorian’s outline of questions comes from her years of researching the psychology of learning, motivating students, and researching Dr. Angela Duckworth’s work on Grit: The Power of Passion and Perseverance (Scribner, 2016). For more information on Dr. Angela Duckworth, you can visit https://angeladuckworth.com/.

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 Recorded in ShowTech Studios, Tampa, FL.

Creator: Louise Krikorian

Years Active: 2025

Season 1, 10 Episodes

Season 2, 2 Episodes

Total Episodes: 12

Length 35:38

Frequency: Updated biweekly

Rating: Clean

Hosted with Buzzsprout www.buzzsprout.com

Transcript

SPEAKER_00 0:05

Hi, I'm Louise Kerkorian, and this is Shaping Our Story, where I talk with exemplary leaders about their passion, their purpose, and their perseverance to encourage you to thrive. Today, our guest, Dr. Robert Gatenby, Chairman of Radiology at the H. Lee Moffitt Cancer Center and Research Institute, is a pioneer of evolutionary oncology. As the founder of the first cancer biology and evolution program in the United States, his work in game theory, mathematical modeling, and adaptive therapy is transforming our understanding of tumor progression, treatment resistance, and precision cancer care. Hello, Dr. Robert Gatenby. Thank you so much for talking with me today.

SPEAKER_02 1:02

Thank you for inviting me. I'm looking forward to it.

SPEAKER_00 1:05

Yeah, and I also would like to thank your wife for suggesting this because I have found in all the research that I've done and watching other videos that you've done, other interviews, other podcasts, that your passion and your courage is inspiring.

SPEAKER_02 1:22

Well, thank you. Thank you.

SPEAKER_00 1:24

Thank you for your work. So I understand that you joined uh Moffat in 2008 coming from the University of Arizona, where you had been a professor in the Department of Radiology and in the Department of Applied Mathematics since 2000. You received a bachelor's degree in bioengineering and mechanical sciences from Princeton University and a doctoral degree in medicine from the University of Pennsylvania in 1977. Then you completed your residency in radiology at the hospital of the University of Pennsylvania, where you served as chief resident.

SPEAKER_02 2:05

Yes.

SPEAKER_00 2:06

So with that background in radiology, your applied mathematics, bioengineering, your research in game theory, your integrative mathematical models, and cancer evolution, which I find fascinating, what would you say is your passion or your greatest interest?

SPEAKER_02 2:31

When I left my residency, my first job was at the Foschase Cancer Center in Philadelphia. And you can't work in a cancer center uh for very long without wanting to contribute in some way to it. And so um what and and so I tried to learn more about cancer, and and what I found was that um you know we we cancer is complicated, um, and it it's it's what's called a complex dynamic system, uh meaning that it has many parts and they interact with each other in complicated ways. The weather is the best known complex dynamic system. Now what we know about complex dynamic systems from physics is that they have nonlinear interactions, which means that that uh human intuition doesn't work very well in them. So if there's a system in which you know, if you get one, you know, you you get two, and then two gets four, and four gets eight. Um human intuition is very good at what at that linear kind of sequence at predicting what's going to happen. Um but if if that's not the case, if you you know one gets two, two gets seven, three gets twenty two, you know, those kinds of things um we're not good at. And and what uh physicists have learned for hundreds of years is that that needs mathematical modeling. Um we we need to capture that with mathematics. Um and so um what I thought I could do to contribute to cancer is to bring mathematics to it, to to really kind of bring this kind of framework of understanding, which physicists have used for decades, uh, centuries. Really, that so physicists work with the experimentalists and the theoreticians working together. It's it's it's uh and and it is what they've used to do do extraordinary things. Um those are things that are not done typically in cancer or in or in biology in general. The use of mathematics is not um is not common uh and still not common, but I think it's essential to really get to the base the the kind of fundamentals of cancer to understand how it works, because um you know, as soon as you do something to cancer, as soon as you apply a therapy, the cancer begins to evolve and change. Um, and those feedback loops add a layer of complexity which we're not currently keep you know taking into account. Um and so and so my my goal is to um ultimately to uh optimize cancer therapy using evolution principles. Um and I think that um one of the one of the things that's happened over the my career is that when I started at Fox Chase, a lot of patients died because there just weren't good therapies. We just for many common cancers, there just wasn't anything that really worked. And now, many years later, um we actually have good therapies for, as as first-line therapies for most common cancers, and yet um people still die. Uh metastatic cancer is still pretty much a fatal disease. And the reason is evolution, is that although we have very good treatments, cancers evolve therapy evolve resistance very quickly. And so I think that increasingly what you can say is that the the reason people die from cancer is is evolution. You know, it it would arguably not be a problem right now because we have good therapies. If it didn't evolve resistance, those therapies would just continue to work, and we really would have cancer as a sort of a chronic disease, even a curable disease. And so um so I think this is really sort of fundamental to this. And I and currently, really for decades, um cancer biologists and oncologists have never used, really thought in terms of evolutionary principles. Um and so I think that it's it's been difficult to you know to sort of get them to kind of integrate that, and um even probably more difficult not to integrate it into cancer therapies. And so that's been a challenge, but I but I think that um you know we're probably this this is probably the best we can do. Um we always talk about the cure for cancer, and and those that concept sort of came out of uh the the success of antibiotics. There was a uh famous uh scientist, Nobel Prize-winning scientist in the early 20th century named Ehrlich, who used who called something like magic bullets, that you would be able to find drugs that that killed cancer cells, but not normal cells. Uh and antibiotics are are arguably an example of that. And so we keep looking for those, you know, that something that will just the magic bullet, the one the the cure for cancer. Um and and there may be such a thing, but we've been looking for a hundred years, um in fact, probably about 120 years now, and it haven't seen it yet. So um I think that it may exist and it would be great if it exists, but in the if if it doesn't, um I think we have good therapies, and if we integrate evolutionary dynamics into this so that we explicitly try to delay or prevent evolution of resistance, um we may not be able to cure cancer, but I think we can convert it into a chronic disease.

SPEAKER_00 8:01

Mm-hmm. I've I've heard you in a couple of other podcasts, and I will I will include the link to those podcasts where you start talking about very specifically about um cancer and um evolution and mathematics and game theory, and your passion just shows through, and everybody on the podcast is laughing because everybody else is at the same level that you are. And I just I find that really inspiring. One of them, one one um podcast I was listening to was Ira Pasteur. He has one called Progress, Potential and Possibilities, and that's where you were explaining that you grew up in Erie, Pennsylvania, and when you were very young, your aunt gave you a book about the stars, the stars in in the sky, and that inspired you to study science. So what I wonder is who was the very first person who inspired you?

SPEAKER_02 9:00

There's certain people that have done things that I don't know personally, but have been extraordinarily um impactful in the way they did things. Um Einstein's probably perhaps the most obvious of these. Um and he uh because he thought creatively um uh when I was in college, um I was struck I I met some of the members of the physics department um who were extraordinarily bright. And and they're they were dazzling to me. I mean, intimidating in the in the way that they had the ability to sort of intellectualize things, to to think about quantum mechanics, for example, like in a it's in an intuitive sort of way, which is astonishing to me. Um the um so I I I I in some ways uh I think I've tried to model myself after the group of scientists who developed quantum mechanics in the early 20th century, Einstein being certainly among the most notable um, but there were many. And what what I admire about them is that they worked together in a way. I mean, you know, humans, there's always going to be some friction, but these guys um worked in synergy. Uh I mean they they they worked as a not as a team explicitly, but uh recognizing that they each were building on the other's work. And um they did so, as far as I can tell, in a way that was cooperative, that they were they had a goal that they were all moving toward in in one direction. And so those are the kinds of things that I admire. Um I I I I guess I can't say that there's any one teacher, for example, that um you know led me to this. It was kind of a cumulative experience.

SPEAKER_00 11:01

And I think you've already touched upon what you believe to be your purpose, which is very important because having a sense of purpose is something that we need in order to succeed. So how would you just summarize in one sentence what you would say is your purpose?

SPEAKER_02 11:20

Um I I I I don't know. In one sentence, I guess I I don't know. I I I feel like um I I need to, you know, contribute these things uh uh to uh to cancer therapy. Um and to be honest, it has never been easy. Uh um I could you know paper the walls and ceiling and floor of my office many times over with rejection letters, um which are quite harsh and sarcastic and and a variety of those things. Um so it it's been a difficult um pathway, honestly. I mean it's a lot it would have been a lot easier to to sort of just do kind of incremental work on what's kind of the the standard dogma. Um and there were certainly times that I felt like this is not worth the effort. Um but what I always sort of came back to is that I think I'm right. And if I don't do it, who is going to do it? Um because there's nobody out there that's that's being terribly supportive. Um and so it sort of came down to that. I I guess um uh if if I had a purpose it would be to um bring my insight. I and and I I I I and I I that maybe is that's probably a sort of a narcissistic statement, but that I think I understand and other people don't. I think the conventional wisdom that's been applied to cancer therapy for for decades um is it's simply incorrect. I mean it and it's it's a groupthink kind of thing, it's become tradition. Um it's it's uh the great professors have sort of um you know pro propagated it for decades, and and I mean decades. Um and I think that that's just plain wrong. Um and as I said if I it it it just if if I don't do it, I don't know who will. Um so um so anyway, I guess that's the sense of purpose I have. Um I I it's it's not well it's not a well-formed idea, to be honest.

SPEAKER_00 13:43

But that makes sense to me, is that your purpose is to take your unique insights and apply it to cancer research. That's what that's how I would sum that up.

SPEAKER_02 13:54

Yeah, yeah. I mean I think that maybe I have the a background and a personality that um, you know, is you know, has this uh combination of things that makes me want to do that. At the same time, I I I also think I'm uh I I've been a good father, a good grandfather, a good husband. I think that I I I don't want to um minimize those things which I think are are are equally important. Um and I've tried to um make sure that I did all those things, you know, as as well as I could. Um so yeah.

SPEAKER_00 14:32

Yeah, well I know you from from knowing Abby, your wife, and and from what she's told me is that you have a very loving family.

SPEAKER_02 14:42

Yes, I think I think so. Um and and I'm very proud of that. I mean I I don't want to it's in um talking about sort of the the personal aspects of my research. Um I don't want to minimize the importance of the other things that are personal to all of us and and um you know I think that we all um want to make an impact with our work, um but we also have to make an impact with our family, you know, with the direct our our the the people that we deal with on an everyday basis.

SPEAKER_00 15:18

So that's true. So what would you say, because we were talking professionally and you said that some people don't agree with what you've said, what would you say is your biggest professional failure and what did you learn from it?

SPEAKER_02 15:34

Um there have been many. Um and that that that's that's at many levels. I I I tell the residents when I sort of approach a radiographic study, I bring the baggage of many misses and and mistakes, you know, and and that the difference between them and me is that I made more mistakes than they have. Um and so um, you know, I I think that um uh I I have a tendency to be um intolerant of people that sort of sort of don't get it, um, and um tend to be um you know if not very good at explaining things. If it's it, you know, if it's in my head, I feel like I I don't need that it must be in your head and therefore I I don't need to explain it very much.

SPEAKER_00 16:31

And and so I think I'm not the only one that thinks like that.

SPEAKER_02 16:37

No, and and um so I I I don't think I'm a very good teacher, and um and that's been a problem because we we uh we meaning the people that that kind of do this don't necessarily have a large number of students uh that have worked with me and with others who then will sort of propagate it on. And and I think that's been a significant um failing uh of what I've done. Um so there's there's many things that I could I could have improved in retrospect. Um unfortunately you don't get do-overs in in this sort of thing. So um, you know, it's just uh you try to do better the next time.

SPEAKER_00 17:20

Mm-hmm. Yeah, the next time. I I say that a lot. I say, well, next time. You know, if something didn't work this time, well, there's next time. Um so it sounds like in some cases, because of your intuition and the way that you look at things a little differently, that maybe things come to you naturally, but that doesn't mean that it's easy.

SPEAKER_02 17:46

No. Um yeah, I it would be a mistake to say that there hasn't been a tremendous amount of hard work in this. Um and um and and thought I I mean I it happens that I uh just had a paper accepted yesterday on a topic that I've that that I started thinking about when I was 16 um and and read a Scientific American article on the topic and have um thought about it and have really actively worked on this particular project for years, um trying to sort of understand it and go step by step through it. Um and so yes, it's it it's I I I think that um what's been important for me is to to learn all continuously, to always explore new ideas, to to try to read broadly in science and but also in you know on other topics, so that there's um this sort of continuous learning process. I I I can't emphasize that enough, I think. There's uh I think there's a tendency to think that you know once you graduate from college or whatever, whatever your sort of tr at the end of your training is, that that's your peak, and then you know, this is you you sort of just stay there, or you simply focus on on the the topic that you are making living at or you know whatever, as opposed to um broadly exploring topics just because they're interesting. And and I think that trying to find connections to to you know to to what you do. There's um I I I had a I was happened to catch an my eye sort of wandered once to a uh thing that was on the internet and it was about um insects that read that that um ate, I think, broccoli, and and I don't particularly like broccoli, so I I was that what appealing to me was these good guys, you know. And it turns out that that the story was about how this insect, which was first detected in the US in the in the mid uh 19th century, has is is still around, has has become resistant to every pesticide ever tried, um, and is still out there eating our crops. And this introduced me to this concept of pesticide resistance, which which is analogous, I think, to the to the uh cancer resistance. And you know, what I realized I had been looking at that as a sort of a physics problem, as a as a problem with how the the the tumor and the treatment get out of sync. They they they they um it's called defacing, which is I think true, but not a not a good conceptual model to use in this you know in this setting. So um as just as an example, so that led me to this uh pesticide management and and how the history of that, which which turns out to be very interesting. Um and you know, so for example, uh high dose pesticides have been forbidden by law since the Nixon administration, that you know, 60 years. Um and yet we use high-dose you know, toxins for for cancer still. Um the pesticide management companies are required by law to uh file what's called the resistance management plan, meaning that you they they recognize that you know they they have to think about resistance. Um there's nothing like that required for the for the manufacturers of of cancer therapy. Right. So though again, that kind of you never know when you know you if you're reading an interesting subject, how it might connect to other things. But I think it's it's important to be open to those connections, to always be thinking about how this impacts, how what it tells you about something else.

SPEAKER_00 21:56

Right. And I I think if I could say this, I think it may. Sense that that inspires you and that and that also speaks to your unique way of looking at things. I remember when I was at the University of Pennsylvania studying in graduate school, I was reading about uh Rachel Carson and how she uh discovered that the birds were were dying and it was because of pesticides. And that was during the Kennedy administration that she was writing about that. But um so just just linking that to something, just a little tidbit of something that I know um inspires me. But it sounds like when you find articles just talking about these insects that are eating broccoli, you you have a very unique way of simplifying things, but then also tying things together to a very, very complex um system, as you had said before. What is it that you hope to do next? Because you had just talked about how you had a um a paper published.

SPEAKER_02 23:05

Oh, that's a topic of interest. Um not necessarily it's it's not directly cancer related. It has some implications for cancer. But um the it happens that today we're submitting a grant. Um I think that we now have enough, I I think we've learned enough from the our pilot clinical trials in prostate cancer to say that we could eliminate metastatic prostate cancer as a cause of death in men. I believe that we now have that we have the necessary treatments and we have the necessary strategies. And so this is uh a a uh uh a grant application to support the the funds that are necessary to use a clinical trial to um fund a clinical trial. We we actually have written the clinical trial, uh, but these but they're very expensive to show that we can do this in a what's called a randomized trial, meaning that you compare it head to head with standard therapy. Um so I I think we can do that. I think we can do that in other cancers, but I think that we've made the most progress in prostate cancer, and and you know, about 40,000 men a year die of prostate cancer in the United States, uh probably about three to four hundred thousand across the world. So it's it's a significant health problem. Um and um because we've learned how to to control it with much less drug, um the toxicity and costs of treatment are are also greatly reduced. So the the quality of life is quite good. And I and I think that's the kind of thing that we need to do broadly in cancer, but but I think we can do it in in prostate cancer. It's the first time I've I've felt reasonably confident that we have everything we need for this. Um good. One of the downsides is unfortunately that um, as I've been has been pointed out to me many times, is that nobody makes any money on this. Um because we use standard drugs, we don't use any new expensive drugs, we use much lower doses of the drugs, um, so that the the the pharma companies have no interest in the pharma companies do they sponsor most of the uh clinical trials in in cancer. And then but there's always a profit motive. You know, they're trying to sell a product and they're trying to get it approved, so this is the the goal of this. And in our case, um there's there's no money to be made on this, and so uh um we have to rely on either the government you know funds or or uh philanthropy or you know foundations and that sort of thing to you know to to pay it. Unfortunately, you know, a trial like this will will cost two million dollars, and and it's not it's not something you can take your credit card out and and and use. So that's a challenge, but I but I do think I I am reasonably confident that we can um we can make very significant progress in this one disease. I think that we can do the same, you know, in breast cancer and some other uh cancers, we but we don't that just the uh the cumulative experience that we've had happens to be in prostate cancer.

SPEAKER_00 26:19

So if someone was just starting out and and studying in this area, what would you recommend to them?

SPEAKER_02 26:31

Um I might suggest they rethink it. Um and and and and there's a reason for this. This this is um you know, we uh if you're an academic person and you know you have to remember that academics live on on the you know the the success is measured in uh publications and grants. Um publishing things that's not in the standard uh way, that isn't isn't consistent with kind of standard dogma is always an uphill battle. Um you know, and getting grants is uh virtually impossible. I mean i you know I've done it, but um, but it takes an enormous amount of persistence. And and when I when I say that I've I you could paper my walls, ceilings, and four many times over with rejection letters, I I'm not really um I'm not kidding. Um, you know, I I have uh papers that have you know been rejected you know 15 times um before finally getting um published, including the one that just that just got accepted. Um and so um uh what I I benefited because I make a living you know doing clinical medicine, clinical radiology, and and so I was able to deal with that those kinds of failures because they didn't directly affect my income or my you know my my my livelihood. So I I I it was it was split uh in that way. But if I were a college professor, um you know I don't think I would have ever survived. Uh career-wise, I mean I would that my career would not have survived. It's because it's really, really difficult um to do this. Trying to um and and it's and it's funny that way because um you know we always think of science as being, you know, every we're we're here about the truth and we want to learn everything we can. Uh but um and we have to be open to new ideas, but it in fact, like you know, that it's we're all human beings, and and unfortunately uh we all get our you know, that sort of this is the way we've learned it, this is what we do. Um it's it's the the way you can get papers written. You you just go, there's a sort of a formula that you can do and and and and and and it's kind of standard, and you know, a lot of papers look like this, a lot of the grants look like this, those are the ones that tend to get you know accepted and and funded and so forth, so that it's um it's swimming against the the stream to to do this. And um it's it's it's difficult. I I think that's why it's um that's why it's hard to um get students interested, for example, because if you try to bridge cancer biology and mathematics, um most people want to be an expert. And so you can be an expert in cancer biology, you could be an expert in mathematics, but uh if you want to do both of them, you you necessarily have to be less expert than other people in each of them. And and that's difficult. People have trouble with that. I I I have trouble with that. I you know this there's it there's something terrifying about giving a talk to an audience that knows more about the subject than you do. Um and um I and I think the students uh recognize that there's uh this is a really anxiety you know provoking you know kind of experience. And I you you um and excuse me just for saying this, but you you you always run the risk of having your ass handed to you know at the end of these talks because there's gonna be people in there that know more about it than you do. And that's happened to me. Um and and um more than once. Uh but the there's a there's a uh a moment when things come together, when ideas from different disciplines suddenly coalesce, and suddenly you've got this, you know, aha moment. I understand this, I I get it, I I I see um I I understand it. I mean I this was a puzzle to me, and now I get it. And you know, this piece of information from somewhere else was the key thing that made everything coalesced into a into picture. There's there's nothing quite like that. I mean, there's there's a you know, it's an intellectual thrill. I mean it's a very geeky nerdy thrill, I'll I'll admit. But um yeah, but there's there's those moments and and so you have to um w sacrifice for that. And the sacrifice is that sometime you're gonna be just dead wrong. You're gonna have you're you're you're gonna be, you know, wander into a a topic and you're gonna think this is the way it is, and and you know, the experts are gonna correct you and sometimes publicly and in an embarrassing sort of way. Um and uh it's a it's a it's a pretty big price, and and um I think people should be aware of that. I I think that the students should be should understand that. I think it would help them if they understood that I'm as terrified as they are. Um and that that and it is I think that one of the the problems is that they think that the professors actually know everything about multiple topics and and when in fact we've we're as stupid as they are. And uh, you know, it it just I just have thicker skins, I think, after a while. Um and that's that that thick skin is mostly scar.

SPEAKER_00 32:24

Oh, okay. Well, I really do appreciate your insights. I do. I appreciate your honesty, and I do appreciate your unique um just the way that you look at everything and the way that you do put um different areas together. What is the best way for our listeners to connect with you?

SPEAKER_02 32:45

Well, um I I you can contact me by by email if you want. Uh I I my uh you know, I'm at the at the Maffic Cancer Center. I get lots of emails. I I get emails from high school students, and I've even had e emails from uh um middle school students uh over the years as they ask me about uh they want to be a scientist, what what what should they be doing and that sort of thing. Um I I try to be uh uh I ha having had the experience of emails from me being ignored by uh you know people that are sort of in power or they're sort of big names, I try to respond to to everyone, um and at least acknowledge them, even if I can't particularly help them. Um and and so I and I think that's um important. I mean, I I just that I it just feels like um uh uh you know we should all be sort of on the same plane somewhere and recognizing that you know we're we're um we all share a kind of common um interest and bond together. Um and you know, I think my goal was to try to promote people um exploring new ideas and being open to new ideas. And um I in this era it seems like we're we're going in the other direction and we're you know progressively closing down to new ideas, and I I I think that's a terrible mistake. I think that's what keeps societies you know where they are and not moving forward. And and so I think it's important that we we try to do that.

SPEAKER_00 34:30

Good, thank you so much. That's a perfect note to end on. Thank you so much, Dr. Robert Gatenby. I'll make sure that I include all the links to get in touch with you. Thank you so much.

SPEAKER_02 34:42

Well, thank you. It was very nice meeting you.

SPEAKER_00 34:44

Nice to continue too. Thank you for joining us at Shaping Our Story, and thanks to Dr. Robert Gatenby, whose consistent pursuit of new ideas is proof that he combines his passion with perseverance. Please make sure to follow him at the Moffitt Cancer Center in Tampa, Florida, and connect with him online at Moffitt.org. If you enjoyed this week's episode, click on follow and leave a comment to inspire us or suggest a guest. And remember, if this made you think, please share the thought. See you next time.