If his doctors’ predictions had panned out, Tamir Gilat would have been dead 10 years ago. In 2011, he was told he only had three months to live. In 2015, they suggested he make a farewell trip. Calling him a medical miracle doesn’t do justice to what transpired. Gilat got cancer three times, with metastases spreading through his body each time, and was almost pronounced dead twice. Three times he beat the odds and the gloomy forecasts.
This feat was no miracle, but rather resulted from human ingenuity. Gilat is alive thanks to groundbreaking cancer research that produced life-saving drugs. “I’m the lab rat proving that cancer research works,” he says. “I figure I’m one of the only people in the world who participated in two clinical trials that yielded life-saving treatments.”
Gilat, a former businessman, played goalie for Maccabi Tel Aviv while studying law in the 1980s. He says he practiced business and commercial law until 2000, but retired from law at the age of 40 to pursue a graduate degree in business administration. In his new career as an entrepreneur, “I started in the mobile phone business in Italy, then working with Brack Capital which was involved in extracting oil from tar sands,” he says.
His illness, as well as his late wife Keren’s, changed his life. Gilat now devotes all his time to raising their daughters and to managing the foundation he chairs – the Israel Cancer Research Fund. He says the foundation has enabled fast, dramatic breakthroughs in treating a disease that afflicts almost every family, and which has hit his family twice. “I’m alive thanks to research. I owe my life to cancer research, which is why I decided this was my way to give something back to society and to cancer researchers,” he says. “I devote my life to spreading the message that we need to invest in cancer research. This is a social responsibility borne by all of us, since this is what will save us and our children, future generations and the human race.”
‘Nothing to offer me’
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When you sit facing Gilat, you don’t see anything unusual. A day after undergoing some aggressive treatment, he looks energetic, talking enthusiastically and passionately, endearing himself to waiters and diners at adjacent tables, who would never guess his convoluted medical history.
His almost unbelievable story begins in late 2010, when he was 48. “I felt that something wasn’t harmonious with my body,” he says. “I felt pain but they couldn’t find anything for several months. They said I had a crack in my diaphragm and suggested painkillers.”
In February 2011, he took matters into his own hands. “After losing eight kilograms (18 pounds) while living on Advil, I went, against doctors’ advice, to get a private CT scan,” he recalls. “I was immediately diagnosed – the night of the test – with two different cancers, in my kidney and pancreas.”
While Gilat had been a healthy man, he had a link to cancer through his father Isaac, who died of cancer at the age of 51, and through his wife, attorney Keren Nahari, who had been diagnosed with breast cancer seven years earlier, a few months after they had met. By that time she was in remission. The dreadful tidings did not leave room for much hope. “One doctor told me it was a waste of time to start getting treatment, saying I only had three months to live. Go take a trip around the world, he said,” recalls Gilat.
Gilat says he never considered that option. “I did some tests and after two weeks underwent difficult surgery that lasted almost 10 hours. They took out parts of my pancreas and attached organs, as well as my left kidney, which was completely cancerous. Then I began chemotherapy. Three months later I was told the chemotherapy hadn’t worked. There were metastases in my liver, and the world of medicine really didn’t have anything to offer me. I was told I had three months to live and that there was no further treatment available.”
This nightmarish nadir was also the first turning point in Gilat’s story. “After I was told my life was essentially over, my angel, Dr. Talia Golan (director of the Pancreas Cancer Center and head of clinical research at Sheba Medical Center) called me and told me about a clinical trial using a drug that was meant to extend the lives of women who carry the BRCA gene and have breast and ovarian cancer,” he says. “They wanted to try it out on metastatic pancreatic cancer patients who carry that gene as well. Since I was found to carry that gene, I qualified for the trial. I was told its objective was to extend life by a few months, while maintaining a reasonable quality of life.”
Golan was the lead researcher in that clinical trial, which involved a drug known as a PARP inhibitor, now known by its commercial name Lynparza. BRCA carriers comprise 15 percent of all pancreatic cancer patients in Israel. Lynparza works by inhibiting a cancer cell’s ability to repair its DNA, which leads to its death and the halting of the disease’s progression. Pancreatic cancer is one of the more lethal types of cancer; most patients die within six months of detection. Only three percent of patients survive after five years, and medicine has very few solutions.
‘The last survivor among 400 patients’
Gilat had to take 16 pills a day, eight at a time. “The rules were rigid: Fast for three hours before and after taking them, making sure to wait 12 hours between each batch,” he recalls. “You switch into pill-taking mode. There are also unpleasant side effects such as nausea, vomiting and diarrhea, but I lovingly kissed each pill, without which I wouldn’t be here today. The end of each month was like the Day of Judgment. You go to the trial coordinator and undergo tests. If they’re OK, you get the next batch of drugs for the next month. If not, you’re sent to a hospice.”
Gilat continued to receive the pills even after the 13-month trial ended due to a commitment by the drug company to continue supplying the drug thereafter. “When I was told the trial had ended, I realized I was the last to survive out the 400 participants who had begun the trial,” he recounts.
Gilat beat all the odds, taking those pills for four and a half years, until the disease reared its ugly head again. “In September 2015, my whole body was full of metastases, including my liver, diaphragm, spleen and the remaining part of my pancreas,” he says. “l stopped receiving the drug.”
But then, when his fate seemed sealed, Gilat got another break. “There was another trial about to begin, which involved a combination of two immunotherapeutic drugs, Ipilimumab (Yervoy) and Nivolumab (Opdivo),” he explains. “Prof. Ra’anan Berger, the head of the Oncology Institute at Sheba Medical Center and an expert in kidney cancer, joined the team that was looking after me. He and Dr. Golan decided I would join the new trial. I decided to have surgery first to remove all the metastases.”
He says this move was unconventional because patients with metastases aren’t usually operated on. “I felt that if they don’t remove most of the cancerous mass from my body, the experiment would fail,” he says. “In fact, all my internal organs save the heart and lungs were partly or completely removed.”
When he recovered from this radical surgery, he started getting a cocktail of the two drugs, once every two weeks, as part of the clinical trial. “You’re allowed to get this cocktail four times at the most, and most patients don’t last for more than one or two doses,” he says.
But Gilat did last, again defying the gloomy forecasts. “The treatment ended in December 2015, and since then I’m only getting Nivolumab,” he says. “They told me this could only last for two years at most, but I’ve been treated with it up to now. Every two to four weeks I’m in hospital for the treatment. The Nivolumab keeps my metastases under control.”
Gilat’s heroic survival is only part of his tragic encounter with cancer. “My wife got breast cancer in 2003 and then got better. In 2012, shortly after I was diagnosed, it returned, with metastases in her whole body,” he recalls. In contrast to him, Keren did not respond to any treatment. “In 2015, while I was undergoing my second surgery, her systems collapsed,” he says. “She was given 48 hours but kept living until June 2017.”
Encountering the fund
Gilat discovered the Israel Cancer Research Fund, which he now heads, during the first round of his illness. “After I got sick someone invited Keren to a home fundraiser for the cancer research fund. She went alone since I was in a bad state. She returned all excited, saying she’d encountered the most amazing organization she’d ever seen, which finances cancer research on a completely philanthropic basis. She told me she’d invited the fund’s representatives for an event at our house in three months’ time.”
He recalls smiling back and telling her, “Are you mad? How can I host anything in my condition?” She assured him they’d invite 30 to 40 people and wouldn’t have to do anything. “I laughed and told her that I knew she’d invite 150 people and that I’d do all the work,” he says. “And that’s exactly what happened.”
The event got personal. “Two cancer researchers came, telling everyone about amazing breakthroughs and new things that were being done in cancer research in Israel,” he says. “I watched Prof. Gal Markel (one of the leading young oncologists in Israel and an expert on immunotherapy) speaking. I saw how everyone was amazed by his reports on new experiments in immunotherapy, which until then had only been a dream. I realized there was a bug here – the researcher was telling us about some wondrous developments, people were listening with interest, but they didn’t really get the significance of it all.”
And you did?
“I’m the lab rat that proved that cancer research works. If it happened to me it could happen to anyone. I wanted to shake them and say: Guys, these experiments are taking place right here and now. We’re saving lives here. Our responsibility is to invest in cancer research in order to save future generations.”
So, he brought them his pills from the trial.
“At that time, I was still a wreck, in the middle of the Lynparza trial,” he says. “I took them out and kissed them, telling them: Look, without each of these pills I wouldn’t be here hosting you. I realized at that moment that this was what I needed to do in life. It was my social responsibility, my purpose to explain to people the importance and impact of cancer research on all of us. That was the beginning of my affair with the fund.”
Gilat explains that seminal event was the first day in what he calls the mission of his life. “From that day, Keren and I started helping the foundation, donating and attending events,” he says. “In 2013 or 2014, the head of the Israeli branch, the late Leah Ziskind, asked Keren and me to attend the board of directors meeting, at the end of which I was told I was the candidate to succeed her.”
He says he wasn’t intending to take the job, “but I realized this was my purpose, perhaps my duty in life.”
The dream team
We met Gilat the same week the NGO named the 69 researchers who would receive grants totalling $4.3 million this year. Gilat boasts the fund has given out more than $4 million annually in recent years. “To date, 2,400 studies have been funded, to a tune of $75 million,” he says. “Every year we make up the dream team of cancer researchers in Israel.”
And yet, Gilat expresses worries about the future.
“I see problems in raising funds among American Jews, for two reasons,” he explains. “One is the insulting and hurtful attitude expressed by Israel in recent years toward a big portion of American Jews. A second reason is that American donors see a prosperous Israel, and they’re annoyed that Israelis aren’t donating.”
He says everywhere he speaks, people ask him how much money is raised in Israel for cancer research. “I don’t understand how an organization such as the cancer research fund, which I believe to be the most significant one in Israel, hardly gets any donations from Israelis,” he says. “After all, cancer affects almost everyone. It’s the social responsibility of everyone to combat it.”
Only 10 percent of the $4.3 million the fund gives annually comes from Israel. “It’s a joke,” he bemoans.
Do donors abroad expect matching funds?
“Yes. They want to see active partnership with Israelis. They see a country with high-tech and valuable companies, with none of these people donating a shekel.”
Gilat thinks the tendency of Israelis to donate less is connected to education and taxation.
“In the U.S., the tax system encourages philanthropy,” he says. “The state has to find ways of encouraging people to donate more. In Israel there is no education to donate to things that are not immediately effective in saving lives.”
He says donors in Israel don’t appreciate the pool of outstanding researchers Israel has. “They should be fighting over who donates more,” he says. “The fingerprints of Israeli researchers can be found in a quarter of the buyouts related to cancer drugs, and there is almost no major research project in the world that is not somehow connected to Israel. It’s our social responsibility to cure humanity of cancer, and with minimal costs.”
When one talks about research and development of cancer drugs and treatments, one can’t ignore the exorbitant price of such drugs, which have grown over time. The drugs that saved Gilat’s life cost tens of thousands of shekels a month. Moreover, many of the drugs now sold at astronomical prices started out as cheap items in a study funded by a grant from the cancer research fund or other philanthropic organizations. Drug companies have drawn from the basic research done here to turn out very profitable products.
Gilat says that his NGO has no rights related to these drugs. “The fund is interested in only three things: saving humanity from cancer, fostering cancer researchers in Israel and having the research conducted in Israel.”
He says he can’t demand royalties when profits are made off ideas that would not have come to fruition without his organization’s support because its funding is only the first step. “A brilliant researcher at the beginning of her career, getting a few hundred thousand dollars from the fund, is only taking her first steps,” he says. “There are many more stages requiring an investment of funds by organizations and institutions en route to a final product.”
Still, having reaped the rewards, Gilat says he’d expect a person or company who buys an idea that was developed through basic research supported by the fund to give something back.
What about the researchers?
“Morally, I expect every researcher who has a successful buyout after being funded by us to donate towards the fostering of further research, returning the grant he received many times over. I want to create a situation in which a very successful researcher makes a commitment to do so.” However, he doesn’t know how many have done so.
Gilat says that life for him now is very challenging and satisfying. “It involves promoting the cancer research fund by raising awareness of the need to support it,” he says. “Another major component is being present for cancer patients and their families, be it providing mental support or a hug, and inspiration, telling them it’s possible to fight it. I’ve supported hundreds of patients and family members.”
His main message is that it’s the responsibility of every Israeli to donate to his fund. “We know how to find the best researchers, giving full philanthropic support, as we’ve been doing for 45 years,” he says. “To me, this is one of the most important Zionist projects there is.”
Finding the best researchers
The Israel Cancer Research Fund was established by American Jewish cancer researchers in the 1970s, following the Yom Kippur War.
“It happened due to a constellation of circumstances” says Gilat. “A worrisome brain drain from Israel began, since there were no budgets for research and development. Moreover, there was a financial incentive at play: Research costs in Israel are a quarter to a third of what they are in the United States. Israeli researchers are very creative and know how to work on small budgets and cooperate with other disciplines, with fewer ego issues. There are also leading research institutes in a small area.”
When the fund was established, three ironclad conditions for distributing grants were set; the researcher had to be Israeli, the work must be conducted here, and the decision regarding the recipients must be made independently in the United States by a committee of 50 North American researchers.
The decision to remove decision-making from Israel was not coincidental or capricious, but very deliberate. “The aim is to neutralize connections, giving everyone an equal opportunity,” explains Gilat. “Most donations in Israel are given to researchers in leading institutions, but here we give an opportunity to researchers on the periphery. In Israel, everyone knows everyone else, and here they don’t.”
Every researcher in Israel can submit a personal grant proposal, which the committee consisting of dozens of leading American and Canadian researchers reviews. “They come once a year to New York for two days, go over the proposals and rate them,” he says. “Out of 150-200 proposals a year, between 50 and 60 are funded.”
He says American philanthropists should donate to cancer research in Israel of all places because it is the place where the most significant research is being done.
“Our researchers are among the best in the world,” he says. “23 percent of the start-up companies that have seen success in cancer research have Israeli researchers involved. Furthermore, the cost of research is significantly lower here. I think and believe that fostering cancer researchers is one of the most significant things one can do to maintain Israel as an academic and social beacon. Without fostering research and the academic world here, we have no right to exist.”