“I have always strived to develop innovative, simple, affordable treatment protocols,” Dr. Banavali says, noting the oral protocol for acute myeloid leukemia he has been using for pediatric patients on an outpatient basis with excellent results. A similar treatment protocol is now being implemented for other leukemias and non-Hodgkin’s lymphoma, as well as for cancers of the head and neck, ovary, breast and gastrointestinal tract.

Under his direction since 1998, Tata’s pediatric leukemia/lymphoma clinic has significantly improved five-year outcomes by modifying existing protocols or adapting new protocols. Five-year event-free survival rates improved from 62% to 86% for T-ALL; from 57% to 76% for non-T-ALL; from 57% to 81% for ALL in children between the ages of 1 and 3; from 42% to 96% in T-lymphoblastic lymphoma, and from 62% to 93% in diffuse large B-cell lymphoma. In acute promyelocytic leukemia, overall survival rates drastically improved from 25% to 79%. 

Dr. Banavali earned a degree in internal medicine at University of Bombay, and completed adult oncology training at Tata Memorial Hospital under the guidance of Dr. SH Advani. During this time he wrote a research project on chronic myeloid leukemia for which he earned a fellowship to work with Dr. Harvey Priesler at the University of Cincinnati Medical Center. He spent nearly three years there, conducting research on various aspects of leukemia and especially the CD 34+ hematogenic progenitor cells.

In 1992, he moved to Memphis, Tennessee, to work at St. Jude Children’s Research Hospital. There he completed his board certification in pediatrics and a clinical fellowship in pediatric hematology-oncology. Within the Department of Experimental Oncology, he worked on a project involving the development and utilization of an in-situ FISH technique to isolate the gene involved in the pathogenesis of neuroblastoma.

“The fellowship at St. Jude was immensely helpful to me. The high level of research and training made me a better-rounded oncologist. But I always knew I would return to India,” Dr. Banavali says. “I wanted to work where I could do the most good.”

Dr. Banavali has been working with INCTR since its inception, particularly in the formulation and execution of various INCTR protocols in leukemias, lymphomas and retinobalstoma. He has also been involved in efforts to develop guidelines for the management of pediatric cancers in low-resource countries.

At St. Jude, he says, the doctor/patient ratio is very high. At Tata Memorial Hospital, doctors see nearly 44,000 new cancer patients every year — 2,000 of whom are under the age of 18 and cared for by only six pediatric oncologists (in the USA, a reasonable ratio would be 3-4 pediatric oncologists for every 50 patients, and most centers would see only 50-100 patients per year!).

As a government-funded cancer institute, Tata Memorial Hospital treats up to 60% of its patients at no cost. The hospital’s goal is to provide a high level of patient care while also supporting research and clinical training in all fields of cancer medicine.

Even with the workload at TMH, Dr. Banavali regularly visits BKL Walawalkar Hospital, and has helped it to develop as a Rural Comprehensive Cancer Center.

As the demand for low-cost cancer treatment grows, so does interest in metronomic therapy, an approach that uses traditional chemotherapies developed in the 1950s, ’60s and ’70s. “Given orally, these therapies are simple to administer, they’re inexpensive — as little as $4 a month, and they don’t require a lot of infrastructure,” notes Dr. Banavali. “This has significant implications for the care of patients in developing countries and elsewhere. The cost of cancer treatment is becoming an important factor, even in the West.”

Marcia Landskroener for INCTR