Sam Gambhir Trailblazer Award Winner: Andrei Iagaru, MD

Umar Mahmood, MD, PhD, and Andrei Iagaru, MD—the inaugural recipient of the Sam Gambhir Trailblazer Award—discuss Dr. Gambhir's life and legacy, including personal and professional recollections. Dr. Iagaru also shares his thoughts on the future of nuclear medicine therapies, what keeps him motivated, and more.

This new SNMMI award was created in memory of Sanjiv 'Sam' Gambhir, MD, PhD, who passed away in July 2020. He was Professor and Chair of Radiology at the Stanford School of Medicine and an internationally recognized pioneer in molecular imaging. The Sam Gambhir Trailblazer Award honors outstanding achievement in excellence in transformative research (either basic science, translational science or clinical science) and exceptional mentorship for mid-career professionals.

Transcript

 DR. UMAR MAHMOOD 0:08 - 3:45 RUNS: 217 SECONDS
Welcome to the latest episode of the SNMMI Podcast Series. My name is Dr. Umar Mahmood. My guest today is Dr. Andrei Iagaru, Professor of Radiology, nuclear medicine and the chief of the Division of Nuclear Medicine and Molecular Imaging at Stanford University Medical Center.  At this year's SNMMI annual meeting, Dr. Iagaru was honored as the first recipient of the Sam Gambhir Trailblazer award, this prestigious award created in memory of Dr. Sam Gambhir, an internationally recognized pioneer in molecular imaging, honors outstanding achievement and excellence in transformative research, either in basic science, translational science, or clinical science, and exceptional mentorship of early career professionals. Welcome, Andrei. And thanks for joining me.  Before we jump in, I'd like to add some of my thoughts about Sam.  So my recollection of Sam is that, of course, Sam was brilliant. But one of the things that really sticks with me was Sam's kindness. And he was kind not only in his personal interactions, but you could always tell how much he cared about his patients. And, you know, I've met Sam a number of times over the years, of course, starting, I think, first time in 1998. And but you can also tell when Sam met my kids at the society molecular imaging meeting in Hawaii in 2006, how he treated them as individuals, and really was listening to what they had to say. And other and so he was just kind in any number of times where I've seen him interact with people of all different walks of life, and all different avenues.  Another aspect that I like to bring out was his vision. And so, when I first heard about precision health, I thought it was probably just a bit too big, you know, to tackle. But then one of the last talks he gave was in November 2019. And I remember being at the talk and how he systematically ticked off a list of milestones he had achieved or 100, you know, Stanford or the larger community had achieved in bringing out the bigger aims of precision health, and so it wasn't too big. And that reflects Sam's ability to have a big vision and to achieve a big vision. The other thing I remember about that last time, I got to have lunch with Sam in November 2019, before he gave his big lecture, and he had at that time widely metastatic cancer, and he gave a brilliant talk. And I remember asking him if he was going to attend one of the receptions that evening and he said, No, that he was flying straight from Chicago, to Munich to get an experimental therapy.  That was Sam, you know, Sam could give a brilliant talk covering precision health and give an update about, decade of progress and where it was, and then fly straight from, you know, on a 12 hour flight to get experimental therapy. So, those are some of my recollections that, I finally remember about Sam.  I'd like to turn it over now to Andrei, to hear about not only the Sam Gambhir Trailblazer award, but some of his interactions. So Andrei, you know, Sam was both a friend and a colleague to you. Can you tell us some of your personal observations about both his life and his work?

| DR. ANDREI IAGARU 3:46 - 7:11 RUNS: 205 SECONDS
Yeah, thank you, Umar, thank you for the invitation to talk to you and be a part of this podcast.  As you're mentioning your recollections about Sam. I was seeing that I was seeing about the same thing, how he could make great conversation with the toddler, someone's kids, and then expand, you know, switch gears and talk to a Nobel Prize winner and beyond same level. So that ability to be fantastic human being across all spectrum of life was amazing.  You brought up RSNA 2019. And he gave that talk, he was actually in a lot of pain. And maybe you recognize if you watch the video that he wasn't quite himself, yet he was able to give a fantastic as you said vision about precision health and yes, usually on Tuesday night, we have the Stanford reception at RSNA and that was on Tuesday and he went straight to the to the airport from there. So an amazing individual.  Needless to say that what are some of my recollections? With my call excuse about how privileged we were to be able to work with him more than a decade and, you know, see him almost on a daily basis and talk to him almost on a daily basis. And everybody knows what a great scientist he was. So maybe I'll share some of the other aspects about Sam, such as, you know, when a young faculty just recruited 2005, 2006, he organized a retreat for a bunch of us. And it wasn't just me, it was David Duke, who's now in Iowa. And Andy Kwan, who's at UCLA and Ted Graves and many others. And he would wake up early in the morning to cook breakfast for all of us. I mean, how many people will do that for the junior faculty? It's all done in the spirit of being collegial. And being a colleague and a friend, not just your boss.  And then what else? Probably not many people know. But he also was qualified as a real estate agent. So he actually went to his my wife and I to look for houses when we first bought a house in 2011. And the one that we like the most the one that he said, Yeah, that's a good one. So that's that. He also encouraged us to get a dog when we first think about getting a dog and he said, Hey, he's going to change your life. And yes, our Bulldog did change our life. And whatever we play, we sing, we sing of Sam as well. And then Sam was available, pretty much to everybody. Anytime of the day, there are patients writing him cold emails, and he will not leave it to his admin to respond to you, to reply to people who write to him from every corner of the world asking for this advice or that advice. And then at work, he was the first one in and the last one to go home. And, you know, when we were residents working with him, and there was a late case, he'll be like, I'm in my office, I'll walk there. I'll see you in a few minutes. So just an amazing individual.

| DR. UMAR MAHMOOD 7:14 - 7:46 RUNS: 32 SECONDS
I have to say that Sam really was larger than life in so many ways. And it, it feels like such a privilege to have been able to spend time with him and know him in so many different ways. And you got to work with him for so many years. How do you think he influenced you? Or what are sort of the things that are part of you now that you, you learned or you internalized with, with your interactions with Sam?

| DR. ANDREI IAGARU 7:49 - 9:31 RUNS: 102 SECONDS
Sam had a very disarming way of getting everybody on board. Everybody wanted to emulate him, which was an impossible task, because, as you said, quite a unique individual. There was no other Sam and there will not be any other Sam, from my perspective. Someone that's just a good human being. And I think that one of my colleagues, Eric Mitra put it the best way, like whenever you're faced with a difficult situation, personal or at work, the question is, what would Sam do? Right? So it brought this not just in me, but in everybody working with him this idea of like, okay, this difficult moment, what would have Sam that, how would have he handled this.  For me personally, in addition to being given many opportunities, because he was very generous with his opportunities, he, would put a lot of things on your plate until you say, I can do this. But beyond that, Sam was really one of the best listeners. And I'm a little bit impatient. So one of the things that I tried to do was, to be able to try to listen as much as Sam was listening to people in the room, and I'm still a far cry from being as good as he was at that. But it's something that perhaps not the one thing that you would have thought I would answer, whether that's one of the biggest things I tried to learn from Sam How to Be a good listener, and how to stay focused on what people in the room are trying to tell you and make them feel that you give them 100% of your time when they come to talk to you.

| DR. UMAR MAHMOOD 9:33 - 10:12 RUNS: 39 SECONDS
And I have to, you know, agree that there's so many aspects, a lot of people when you first superficially look at Sam's brilliance, you get dazzled by, you know, the science and what he and what he's able to have accomplished. But in a lot of ways, it was his personal traits and who he was as a human being, that I think we can all learn from what you're saying.  You're the first winner of the Sam Gambhir Trailblazer Award, which incredible honor and a huge deal. So what does winning that award mean to you?

| DR. ANDREI IAGARU 10:15 - 11:23 RUNS: 68 SECONDS
I still remember when I got the email that and the winner, and I was overwhelmed with all sorts of emotions, because I mean, it's a cliche, you'd give away any award just to spend some more time with Sam. But that's obviously not possible. It is an incredible honor.  And as I said, in Vancouver, I will take it on behalf of all of us at Stanford, because I think that what Sam left behind is not one individual or one grant or one paper, it's the theme that he was able to assemble and put together and how motivated everybody is, despite challenges to carry forward, his vision, whether the patient needs early cancer detection, whether that vision is having the best residency program in the country, whether that vision is improving equipment, continuing research, everybody's motivated to keep that going. So although an incredible honor, on a personal level, it is I think, best to monitor the work that the entire team at Stanford, is continuing to do on behalf of Sam's legacy.

| DR. UMAR MAHMOOD 11:24 - 11:56 RUNS: 32 SECONDS
And I think that that's very, very nicely stated. And speaking of the groundbreaking work that's been done at Stanford, so you have you're right in the middle of seeing a lot of the future of nuclear medicine. And from your perspective, what are some of the big opportunities to improve patient outcomes in nuclear medicine that are to come in the next, let's say 10 years, five years, 20 years? However far forward you can look?

| DR. ANDREI IAGARU 11:59 - 12:04 RUNS: 5 SECONDS
Obviously, if we knew that, both of us would be somewhere else 

| DR. UMAR MAHMOOD 12:03 - 12:05 RUNS: 2 SECONDS
[chuckles]
yeah, right.

| DR. ANDREI IAGARU 12:05 - 13:43 RUNS: 98 SECONDS
But to the extent that I can say a few words, I think that, you know, we witnessed the revolution in the past decade, right with luta, Terra and convicted and helping patients with neuroendocrine tumors and prostate cancer. And this did not come out of nowhere. This came from decades of work by many people in the field. And I think that now, there is a genuine interest from outside to support nuclear medicine, that it's the right time for us to bring forward novel things like new ways of imaging infection, for example. Cardiovascular disease, is not all about cancer, although probably 80% of what we do in our clinic, it's oncology. There's a large unmet need in other parts of the healthcare system.  So I think that this is the right time, the right energy, the right people, in our extended nuclear medicine community to really advance the health of populations that we serve in ways that perhaps we can't even fully imagine. There will be a slew of innovation coming from young people joining the field.  If you go to the SNMMI, if you go to other professional meetings, there's so much energy, there's so many young people going into nuclear medicine and related fields, that it makes me very optimistic that we're only scratching the surface of what will come as contributions to overall medicine from our field.

| DR. UMAR MAHMOOD 13:44 - 14:05 RUNS: 21 SECONDS
I have to completely agree with you. I think nuclear medicine is go it goes through periods of bursts of creativity. And I see the next decade as one of those periods where there's just a burst of creativity in tracers and instrumentation and so many avenues. And so I think it's a great time for all of us to be in the field.

| Music up AD BREAK -  

 | DR. UMAR MAHMOOD 14:08 - 14:41 RUNS: 33 SECONDS
One of the areas that you touched on a bit was there agnostics in therapy and I know you're planning the next SNMMI therapeutics conference, where do you see the future of nuclear medicine therapies and whether that's in particular with the therapeutics conference, but also more broadly in the next couple of years? You know, as you mentioned, the successes of neuroendocrine tumors and prostate cancers. What do you think are some of the wins that we're going to have as a field in the next, let's say five or 10 years in therapy?

| DR. ANDREI IAGARU 14:43 - 16:19 RUNS: 96 SECONDS
I'm just a small part of the planning for the diagnostics conference therapeutics conference. I think that we need to expand to other cancers that have areas of unmet need. Glioblastoma multiforme works for ovarian cancer, pancreatic cancer, we can play a role. I think that the entire spectrum from early detection of this, and there I will talk about integrating alpha v, beta three, alpha V beta six. They're not new, they've been studied. But there's a renewed interest in this. And there are many groups in the world that are looking at that.  FAPI, of course, everybody is talking about it. And it's useful across a spectrum of diseases. There's been, there's going to be more and more of these, the conference itself, it's more of a nuts and bolts for practitioners. So I think that it will be set up in a way where people who perhaps don't have a lot of experience in this area will leave the conference feeling readier to start the program, having learned from people who have done that already. And I think that in some ways, we'll try to make it a bit of a teaser for the larger annual meeting where more ground-breaking research is presented. So a little bit of whetting the appetite of attendees to keep coming to the SNMMI meetings, because they're a good mix of what do you need to know to get started all the way to Okay, this is cutting edge research, and science.

| DR. UMAR MAHMOOD 16:20 - 17:11 RUNS: 51 SECONDS
And I think that that's a really important point that there are other large academic centers that do a lot of theranostics. And there are a lot of patients who don't always have access to these large academic medical centers. And so the ability to disseminate that to get into a broader community of nuclear medicine physicians around the country around the world, so that more patients can benefit, I think is such an important, such an important thing that SNMMI is doing that you're doing as part of that conference and, and having people learn how to bring it to their institutions. And I think just in terms of the sheer number of patients that can benefit. It's part of the natural process where things started in academic medical centers, and, move forward. So I think that that's wonderful.

| DR. ANDREI IAGARU 17:12 - 18:26 RUNS: 74 SECONDS
I also think that, by any means, we're not a big center, if you look just that size, so there's limited resources. So once you get to diseases, like prostate cancer with large population that need these kinds of treatments, it's only natural that after the initial experience, that expertise is shared, as you said, with the community, we can serve as Proctor's at all of the centers throughout the United States. And ultimately, we transition to being the places where complex patients that need multidisciplinary care are referred to, while the simple garden variety cases can be treated in the community. I think that that's a model that's more resource efficient because even our centers cannot accommodate all the patients that come their way. And in fact, one of the philosophies that was deeply embraced by Sam is for us to bring the care where the patients are. So of course, sometimes because of logistics, this is not easy, but we should be mindful to not having the patients having to travel hundreds and 1000s of miles to get treated, they should have access to the treatment in a safe way where they live.

| DR. UMAR MAHMOOD 18:29 - 20:47 RUNS: 138 SECONDS
I think that's sort of one of the focuses of the society where, where I remember, you know, some of the early neuroendocrine work was done in Europe and patients from the United States were flying to Europe. And then now there's so many cutting-edge tracers and therapies being done across the United States and academic centers. And I think, you know, you're absolutely right, when we think of all the patients with prostate cancer, and how many of those could be who could benefit from some of the prostate radiotherapies. And then the other cancers, like you were mentioning, you know, with alpha V beta three or other targets, that the ability to get this out to a broader range of patients is really helps everyone and helps the health of helps, you know, across patients across the United States and around the world. So I think that that's where I agree with you that it seems like that's where a lot of these therapies are going to be heading.  So let me sort of switch gears a bit and turn to you know, you talked about Sam being not only a brilliant scientist and caring but, the story about him helping you buy your house or convince you to buy a dog or cooking the junior faculty breakfast is something that I think very few Leaders are that giving. And that's such a incredible, speak so highly of Sam. And part of that relates to his mentoring of many of us in his thoughts. And you're fairly involved in mentoring, early career in mid-career in individuals at Stanford in your role as division chief and other roles that you have at Stanford. What do you see are some of the challenges in bringing people in and keeping people who are brilliant or bright or who are enthusiastic in nuclear medicine? Because it's a tough time to do research and clinical care in medicine? So what are some of the things that you see that are challenges? And what do you think works?

| DR. ANDREI IAGARU 20:49 - 22:25 RUNS: 96 SECONDS
You're right, it is a long game, you need people who want to play the long game, not the short game, not the medium game. Getting a research project from bench to bedside, it's usually more than a decade, right? So someone has to be motivated and like what they do enough to commit that time to them. So I think that there are many challenges some having to do with, for example, we both live in areas where the cost of living is high. And doing research and alone, on a large proportion of your time, is not exactly how you can afford to live in places like this. But I think for people who love what they do, giving them projects, giving them the opportunity to build things themselves, is very important. And Sam was able to give all of us projects and things that he was not a micromanager, he would allow people to do their things. He put trust in people. And he trusted them that they will do their work. So he will not micromanage. So I think that empowering junior people to actually be able to take on projects of continued importance is one way to keep them motivated and keep them in the field. The rest is already primed, as you said, there is no better time to be in Nuclear Medicine than it is now.

| DR. UMAR MAHMOOD 22:27 - 23:28 RUNS: 61 SECONDS
I think that there's a lot as you said, we both live in expensive areas, and the cost of living goes up and people have so many competing demands. And it's always interesting to me, because I see this is a time where there's so many more just discoveries and developments, whether it's new tracers, new hardware, artificial intelligence, and in ways that really will fundamentally, change how we help patients. And so I feel what you're saying about the challenges of keeping people in, even though it's such an exciting time.  So I think you stated that very well. And as part of that, how do you keep going, like you said, you know, I think you and I both spend the majority of our time doing research, we do clinical care. And there's always a lot of hats that we all wear. And you know, you're running a clinical service, and you're trying to do work on an oral one, and mentor people and give talks at national meetings and do everything else. So how do you stay motivated to do all of that? And how do you keep up with that?

| DR. ANDREI IAGARU 23:39 - 24:36 RUNS: 57 SECONDS
I think actually, this part is the easiest of all the questions so far, because I love nuclear medicine, I love what I do. And even when the times are difficult or hard, I think of what a journey we've had as a field. And how much more is there for us to do. And it's not small words, we’re helping patients, everything that we do, ultimately, improve someone's life. And knowing that you love what you do on a daily basis and loving working with the people that you work with the team that's there. It's really a second family. So that keeps me going. And I hope people keep me going for quite a good number of years from now on.

| DR. UMAR MAHMOOD 24:37 - 25:31 RUNS: 54 SECONDS
Very well stated. It's always sort of, how do you balance everything but you're right. If you have the passion and you love what you do, makes it easier. And right now you're involved in a lot of different research pursuits. So let me ask you not from the field’s perspective, but from your own personal research perspective, what are the two or three things that you're most excited about what you're doing? I mean, obviously, the field is moving forward and a lot of different ways. But what are some of the most exciting things you're doing now? That will be like, Wow, that was a great paper by Andrei, do you remember reading that paper in 2023? Or 2024? That he was senior author on that? Oh, my gosh, that was really, really exciting. What are two or three areas that you think that? You say, Wow, that's cool.

| DR. ANDREI IAGARU 25:32 - 27:51 RUNS: 139 SECONDS
First, you're very kind with your words. I hope that will be the case. But you know, people know that I've been working with bombesin for about a decade now, the gas-releasing peptide receptor. And the timing of it coincided with the explosion of interest and how good PSM is. So that made it a little bit more difficult to stay focused on bombesin for example, in prostate cancer, it's a pan-cancer probe. And now that there's two, three, maybe four PSM agents coming to market already on market, people are starting to put their interest into other targets as well. And one of them is in the bombesin. So I think that you will see more and more trials in PSA-negative prostate cancer, for example, in estrogen receptor-positive breast cancer. Again, it's a pan-cancer target. We're also ready for gen two of these probes. We had first [Tiger nice], they don't quite work, we switched to antagonist generation one, now we're ready to go to generation two, I think that this will be very successful.  I mentioned earlier the families of integrating alpha V beta three for angiogenesis, alpha V beta six for tumor fibrosis. The angiogenesis has been largely abandoned, with some of them not-so-positive stories about some of the drugs on the market. However, I think that it will come back, and then the tumor fibrosis markers will also be even in wider use than they are now. So if I were to name a few, these are the ones that come to mind that I'm actively working with. And, of course, I will be contradicted by what will happen in the next decade or so because that's the beauty of science, you don't know where you go until you get there. And, again, coming back to Sam, as he used to say it's called research for a reason because it isn't ever done on the first attempt or even on the 10th attempt. It takes, dedication and knowing that you do something that you like, and also, sometimes let's be frank, knowing to let go of something at least for a while. If the tide is against you.

| DR. UMAR MAHMOOD 27:53 - 29:05 RUNS: 72 SECONDS
Yeah, I think you're right about the challenges of research. And when you have a win, you have to celebrate that. But I think you're right that it does take about a decade. And that reminds me of Sam's talk in 2019, about ticking off some of the things that he had predicted about precision health and then achieving them. So it's good to sort of have your framework about things where no one's gonna hold you to exactly what you said today about what you think it's going to be big in your own research, but it's good to know. So as an expert in the field, what you think is important about what you're doing.  Any other final thoughts about Sam, you know, I, You've obviously done so much. But it's wonderful to hear as the first recipient of the Sam Gambhir Trailblazer award, how Sam has interacted with you and sort of that you know, the osmosis of spending so many hours and days and you know, mindset with him. Are there other thoughts that you want to share about Sam, that just over the years that you've known him?

| DR. ANDREI IAGARU 29:07 - 30:59 RUNS: 112 SECONDS
I will get to that in a moment. I will also want to state how grateful myself, our family at Stanford, Aruna Sam's wife, and others, that our Society decided to have this award. It's a nice way to remember Sam, to be grateful that there's also a symposium every year at Stanford that we choose folks this year. There will be a young investigator award at PNM in the fall. So we have an exhibit of some of his awards, many of them from SNMMI that are put on the wall in the nuclear medicine clinic. So we're looking at ways to keep his memory alive. I think that the world would be a much better place See all of us will try to emulate a little bit of what Sam was. And definitely, our scientific community will be better if all of us try to be as transparent as open as scientifically motivated to find answers as Sam was.  And I'll end that. You know, you asked me what, what else to say about Sam, he was about every single father figure to all of us who worked with him, someone whom all of us knew that the door was open, night and day if we wanted a piece of advice if we wanted some support if we just wanted to talk about things we've seen, so no matter how busy he was, he always found time for the people to have access to him. And then they seem that that's what they find his legacy is his openness, and desire to help others.

| DR. UMAR MAHMOOD 31:02 - 31:37 RUNS: 35 SECONDS
That was just a wonderful note to end on. So, so thank you.  And I want to thank everyone listening for tuning in to this latest episode of the SNMMI  podcast series, and I'd like to thank my guest, Dr. Andrei Iagaru, for taking the time out of his busy schedule to chat with me today about being the first recipient of the Sam Gambhir Trailblazer award. So Andrei, thank you. And it was really a pleasure to talk to you today.
 
 | DR. ANDREI IAGARU 31:38 - 31:39 RUNS: 2 SECONDS Thank you, Umar.