On July 2, Kenneth DeSantes, MD, Crawford Professor of Pediatric Oncology and professor in the Division of Pediatric Hematology, Oncology, and Bone Marrow Transplant, stepped back from his lengthy career in research and clinical practice and stepped into retirement. During his time here, he has held numerous leadership roles, including serving as director of the Pediatric Hematopoietic Stem Cell Transplant Program at American Family Children’s Hospital since he joined the faculty in 1998. Other leadership roles he has held during his career include clinical director of Pediatric Hematology and Oncology, and division chief of Pediatric Hematology, Oncology, and Bone Marrow Transplant.
Throughout his career, DeSantes has had a profound impact on the treatment of children with cancer and other hematologic diseases. His research has focused on the use of natural killer (NK) cells and hematopoietic stem cell transplantation to treat neuroblastoma and other pediatric malignancies. He was instrumental in establishing the University of Wisconsin Carbone Cancer Center as a Children’s Oncology Group-designated transplant center. The Children’s Oncology Group is a National Cancer Institute-funded clinical trials organization and the world’s largest group devoted exclusively to childhood and adolescent cancer research.
DeSantes established and led the state-of-the-art 131I-MIBG Treatment Program to treat children with neuroblastoma at American Family Children’s Hospital. This treatment process uses metaiodobenzylguanidine, or MIBG, to carry radioactive I-131 specifically to patients’ tumors, where it targets cancer cells. The establishment of this program was a complex process that took over five years to complete and involved coordination with multiple specialties.
“Ken DeSantes brought to Madison his intelligence, kindness, generosity, collegiality, and gentle approach to leadership and medicine,” said colleague and fellow division member Paul Sondel, MD, PhD.
“Ken has had a tremendous impact on our division,” added Christian Capitini, MD, professor and chief of the Division of Pediatric Hematology, Oncology, and Bone Marrow Transplant, “including obtaining and maintaining [cellular therapy] accreditation for our bone marrow transplant program, establishing American Family Children’s Hospital as one of about two dozen 131I-MIBG centers in the country providing radiopharmaceutical therapy for children with neuroblastoma, and leading our clinical trial program. We are grateful for his hard work, dedication, and most of all, his magic!”
Five Questions for Dr. Kenneth DeSantes
How has your career surprised you, compared to how you had expected it to develop when you began?
One of the main reasons I came [to the UW] was that very early in my career, I was interested in using immunotherapy to treat pediatric cancer. There weren’t a lot of people working in that field at the time. That was something I was very passionate about and interested in, but it wasn’t very popular back then. One of the most surprising things in my career is the fact that immunotherapy has turned out to be the most exciting area of cancer treatment, both in kids and adults today. The idea that this was going to be an important component of cancer care was actually realized in a relatively short period of time.
Early on there were a few small trials using monoclonal antibodies, which are just antibodies that recognize molecules on the surface of the tumor cell and help direct the immune system to kill the cancer. Some were moderately successful and some really didn’t show much promise. And then one of the big breakthroughs in our field came from the recognition that these kinds of antibodies seem to work much better if you use them at a time when there aren’t a lot of cancer cells around. The best example of that is research my colleague Paul Sondel led using monoclonal antibodies to treat neuroblastoma. There was a pivotal clinical trial conducted where children with neuroblastoma underwent traditional cancer therapy and then were randomized to receive this antibody treatment or not, after finishing standard therapy. The use of this antibody improved the survival of kids by about 20%, which was a really significant leap forward. That was one of the first really strong indications that immunotherapy was an important tool in the treatment of pediatric cancer.
What do you consider to be your biggest achievement?
I guess one of the most important things that I led was establishing our center as an MIBG treatment center for patients with neuroblastoma. Iodine 131 is a very potent radioactive compound. So [MIBG] is a form of systemic radiation therapy. In what you typically think of as radiation therapy, a radiation beam is directed at the cancer. But with certain diseases, like neuroblastoma, patients often have widespread disease. That’s the advantage of MIBG treatment. You basically treat all the cancer sites at the same time. But it’s also a very dangerous type of therapy to all the people around, because the radioactive iodine is giving off radioactive particles that travel quite some distance. Thick lead shielding is required to contain the radiation, and there are many other radiation safety concerns that must be addressed. You need to establish a comprehensive program involving not just pediatric oncology, but nuclear medicine, radiation safety, medical physics, nuclear medicine pharmacy, nursing, social work, and child life are all involved. When I first arrived here, there wasn’t a pediatric facility to do this. When we designed the new children’s hospital in 2007, we were able to convince hospital administration to build us an MIBG treatment suite. We have a lead-lined room up on P4, with a parent sleep room next to it equipped with a closed-circuit AV system (so parents and child can easily communicate). When I came to UW, there were maybe a dozen MIBG treatment centers in the whole country and nothing in our area, so we got referrals from all over the region. We subsequently helped some of the other centers develop their own programs. Now there may be about 25 centers in the country that can do this. I think it put us on the map in terms of becoming a treatment center for children with neuroblastoma.
What has been your largest obstacle to overcome?
That’s a tough one. I think it has been really needing to have multiple discussions with hospital administration to bring some of these cutting-edge therapies to our facility because they’re expensive. This MIBG room, I believe, is the most expensive room in the children’s hospital, for example. When chimeric antigen receptor (CAR) T-cell therapy was first developed, our center was invited to be one of about a dozen pediatric centers participating in the first multicenter trial to obtain FDA approval for this exciting treatment. It took a lot of convincing for our hospital to allow us to participate because the price tag was expected to be so high. We like to say the UW delivers remarkable care, but a significant component of that is having the resources to develop, or at least offer, novel cutting-edge therapies to our patients. So that perhaps has been the biggest obstacle.
What advice would you offer to new physicians just starting out?
I think that to be successful in academic medicine, you need to identify and area within your field to truly focus on. Everyone wants to be able to do everything – great! But in order to excel in your academic career, you have to establish a niche for yourself, whether it be in clinical research, laboratory research, or teaching. Something you can really take ownership of and say, hey, this is mine — I created or discovered this. I didn’t realize that until a bit later in my career. People have to ask themselves, what am I passionate about? And where are the gaps in my field that need to be improved upon?
Do you have specific plans for your retirement?
I would like to stay involved in some of the clinical research projects that I have been working on over the past few years. For example, we are in the process of developing a methodology to activate and expand natural killer cells to treat children with certain types of cancer. We had a clinical trial up and running just before the pandemic, but the study was suspended because the Waisman Biomanufacturing Facility had to shift its resources to COVID-19-related projects. So we’re in the process of reinventing that trial, and I’d like to stay involved even after retirement.
Also, I’ve been collaborating with my son, Adam, to develop a virtual reality video game for children with cancer. He is a self-taught game designer, and we’ve been working together on this for the past year. Progress has been slow because I have been so busy. However, after I retire I think we’ll rejuvenate our efforts. The idea [of the game] is that you’re inside a body and you have different weapons at your disposal to kill cancer cells. We are trying to improve patients’ feelings of self-reliance, autonomy, and hopefulness by playing the game. That’s something I’d really like to get off the ground.
Magic has been a hobby of mine for a very long time, and I’ve integrated it into my practice for many years. I think most of my patients probably won’t remember much of what I did for them as a physician, but they are likely going to remember the magic tricks I showed them! That’s one of the hobbies I would really like to focus more on after I’m retired. If you need a magician for a party — just let me know!
Photo by Bob Gordon/Department of Pediatrics