How One Man’s Optimism Transformed Genitourinary Oncology

Primo Nery "Lucky" Lara, Jr, MD, has been beating the odds since day one. He earned his nickname after surviving past infancy when other family members were not as fortunate. The start of his story paved the way for a lifetime of tenacity, curiosity, and achievement rooted in his desire to create a world where the people he cares most about— his family members and his patients—can thrive. Lara’s determination drove him to craft a multifaceted career that has earned him recognition as the 2025 Giant of Cancer Care in Genitourinary (GU) Cancer.

Aligning Professional Purpose With Personal Pursuits

Growing up in Manila, Philippines, Lara admired the grit and forward thinking displayed by his mother, Merle, who raised 8 kids as a single parent during the Marcos dictatorship.

“A lot of where I am today and my decision to pursue medicine was in part influenced by [my mother] and seeing her struggles,” he shared. “The safety of being in a health care career, such as medicine, would give us more.”

Lara saw a level of stability in the medical field that would allow for the financial

security and career advancement he hoped could one day benefit his entire family. He earned his undergraduate degree in biology at the University of the Philippines and later attended the university’s College of Medicine in Manila.

However, his path toward oncology was peppered with career pursuits of all kinds, particularly those involving writing. During medical school, he wrote a regular column and feature articles for various newspapers, such as the Manila Standard and the Manila Times. Lara wrote about health and other general-interest topics, but he reflected most fondly on his time writing about pop music. Although his resume showcases a multitude of skills spanning a variety of industries, his passion for learning and innovation has always been at the heart of his career decisions.

After graduating from medical school in 1992, Lara decided, like many of his peers, to receive postgraduate training in the US. He matched at the Rush Presbyterian-St Luke’s Medical Center in Chicago, Illinois, where he completed his internship and residency in internal medicine. However, furthering his education was only part of his impetus to move to the States. Over the years, his mother had been bringing his siblings to California one by one to create a life for her children away from the unstable political environment they were living under in the Philippines. Lara later joined the rest of his family in the Golden State, pursuing a hematology/oncology fellowship at the University of California (UC), Davis School of Medicine in Sacramento, where he has stayed ever since.

Leading the Charge With Hope and Strength

“I’m proudest of what I’ve built as director of our National Cancer Institute [NCI]–designated comprehensive cancer center in good times and in tough times,” Lara said.

He acknowledged the inherent challenges in academic medicine, biomedical research, and patient care. However, he emphasized that these challenges have been met with the utmost resiliency and stability from his colleagues at UC Davis, who have worked to expand cancer research and care regardless of the obstacles they have faced, such as negative clinical trial results that halt forward momentum.

“The fact that I am an oncologist makes me, by definition, an optimist,” Lara explained. “Being an optimist helps me ground myself in what patients go through themselves when they’re faced with a diagnosis of cancer or starting a cancer journey. At some level, there needs to be optimism in that patient that he or she will be okay, even when being okay doesn’t necessarily mean [they will] be cured, but [that they will] still be okay, and that their family or loved ones will be okay.”

This patient-focused optimism extends into every aspect of Lara’s career, including his roles as the cancer center director and executive associate dean for cancer programs at the UC Davis School of Medicine. When an issue arises at the institution or in the larger oncology field, he thinks, “we have to tackle this, because at the core of this, somebody will be affected, somebody will benefit, or somebody may be touched by the decisions I make, and that somebody is a person with cancer or at risk of developing cancer.”

Giving and Receiving "Unsolicited Advice"

One of the roles Lara has been “so proud” to play is principal investigator (PI) of the Paul Calabresi Clinical Oncology K12 Program, funded by the NCI. Through this grant, Lara has helped several of his mentees receive research funding which they have leveraged to advance their careers. This program trains clinical oncology scholars in areas such as coursework, career development, core competencies, and mentored research in their chosen project. During the training period, scholars develop their own investigator-initiated trial and learn how to secure funding for it.

“I understand what is needed, what infrastructure [and] level of support early-stage investigators require,” Lara said.

Lara’s passion for mentorship is evident in every opportunity he takes to give advice to the next generations of oncologists. One of his biggest pieces of advice to connect with strong and supportive mentors is directly related to his gratitude for the people who took him under their wings when he began his career.

Being an optimist helps me ground myself in what patients go through themselves when they’re faced with a diagnosis of cancer or starting a cancer journey.

Lara credits Philip Bonomi, MD, a lung cancer specialist he met during his residency at Rush, as the first person to stoke his interest in oncology. At that time, Lara’s innate optimism about the oncology field was swayed by many people who described it as a “depressing specialty.” He acknowledged that up until only a few decades ago, patients with advanced cancers had limited treatment options, and much of the oncologist’s role pertained to palliative care as opposed to active, systemic treatment. However, Bonomi transformed Lara’s perception of cancer care through his enthusiasm for clinical research.

“I saw even then that there was a remarkable opportunity for creating [an effect on] people’s lives,” Lara remarked.

Bonomi’s mentorship extended to his recommendation that Lara pursue a fellowship at UC Davis, where he could benefit from the mentorship of David R. Gandara, MD, the 2017 Giant of Cancer Care in Lung Cancer—then a rising star in thoracic oncology, which was one of Lara’s clinical interests. However, what most grabbed Lara’s attention about Gandara was his involvement in drug development. Lara’s passion for drug development was deepened further by the mentorship he received from James H. Doroshow, MD, of the NCI, who at the time was highly involved with phase 1 clinical trials at City of Hope in Duarte, California.

Later, he expanded his mentorship team to include GU cancer experts such as Nicholas J. Vogelzang MD, a renowned medical oncologist who was a leading voice in innovative clinical trials, Frederick J. Meyers, MD, a GU clinician-scientist and master educator at UC Davis, and Ralph de Vere White, MD, a urologic oncologist and thendirector of the UC Davis Comprehensive Cancer Center. These experts and others expanded his thinking on the infinite possibilities of improving patient outcomes with innovative new systemic therapies.

Recognizing "Limitless" Research Opportunities

During Lara’s time at Rush, he started a research project with Bonomi examining barriers to clinical trial accrual that continued throughout many stages of his career and culminated in a 2001 Journal of Clinical Oncology paper that would become one of his most frequently cited works, with wide-reaching influence.1 Lara and colleagues conducted a prospective study to track factors that may have affected clinical trial accrual rates at UC Davis, including oncologists not considering clinical trials due to perceived protocol/enrollment criteria deviations; patients not meeting trial eligibility criteria; and patients declining trial enrollment for reasons that included desire for other treatment, distance from the cancer center, and insurance denial. Following the publication of this work, in 2002, a California law was implemented that required insurance companies to reimburse patients for the routine costs of care incurred during participation in cancer clinical trials.

Since then, Lara has continued research in this area. Notably, Lara was the senior author on a 2008 study investigating the use of a mass media campaign to overcome barriers to clinical trial accrual.2 He has also been an investigator on studies investigating racial disparities in treatment outcomes and clinical trial awareness.

“I was seeing back then the limitless possibility to positively change outcomes for people with cancer,” Lara reflected. “This was a field that was about to turn for the better. What the state of oncology was at that time could not possibly remain that way. There was an opportunity for science and research to turn the tide, and it did.”

Lara’s relationship with his mentors also strengthened his resolve to develop new treatment approaches to flip the script for oncology outcomes. From phase 1 studies to pivotal trials, Lara has been involved in several research projects that have strengthened the GU cancer treatment paradigm. Notably, he was the senior author on the primary progression-free survival (PFS) readout of the phase 2 SWOG 1500/PAPMET trial (NCT02761057),3 which led to the inclusion of cabozantinib (Cabometyx) as an NCCN preferred regimen for the treatment of patients with advanced, pretreated papillary renal cell carcinoma (RCC). Lara was also integral in mentoring the study’s primary author—Sumanta K. Pal, MD, FASCO, currently a medical oncologist at City of Hope in Duarte—showing him the ins and outs of navigating the NCI’s clinical trial networks across several sites.

Recently, Lara was also the senior author on the phase 3 EVEREST study (NCT01120249) of adjuvant everolimus (Afinitor) vs placebo in patients with high-risk RCC following nephrectomy, which confirmed that this systemic therapy should not be used in this patient population.4 Although not every trial he has been involved in has been practicechanging, Lara is proud of the opportunities he has had to “leverage and learn maximally from those trials by performing innovative translational and correlative studies.”

To this end, Lara was the translational medicine chair of the phase 3 SWOG S1216 trial (NCT01809691), which investigated androgen deprivation therapy (ADT) plus orteronel (TAK-700) vs ADT plus bicalutamide (Casodex) in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC).5 This trial showed that treatment with orteronel plus ADT resulted in statistically significant improvements in PFS and prostate-specific antigen response and set a new landmark for overall survival (OS) estimates in this patient population. Lara continued this work by leading another translational correlative study of SWOG S1216, which showed the association between highly elevated serum markers of bone metabolism and worse OS outcomes among men with mHSPC and documented skeletal metastases.⁶

Notably, much of Lara’s research has been in the realm of publicly funded clinical trials, of which he is a passionate advocate. “We need to ensure continued support for this critical and essential national resource,” he emphasized.

Seeking a Multidisciplinary Specialty

Lara’s specialization in GU oncology was largely influenced by his passion for team science, which was uniquely represented in this oncology subset.

“In GU oncology, what was fascinating to me…was it required, even back then, frequent and robust interactions with other specialties; these malignancies are best approached with a team,” he emphasized.

From seeking input from pathologists to factoring in the roles of radiation oncologists and surgeons, Lara said he “felt comforted by the fact that we were maximizing the brain power of all of these specialists for the betterment of an individual patient.”

This enthusiasm for multidisciplinary efforts is at the core of Lara’s cancer center leadership. When he invests in research opportunities, he prioritizes supporting multi-PI projects that bring together experts from across disciplines. His belief in the power of collaborative, interdisciplinary team science has brought together countless experts who share his goal of maximally improving cancer research and care.

Early on, Lara also saw immense potential to explore his interest in early drug development in patients with GU malignancies. One of his big draws to this field was the “fascinatingly different” biology between kidney, bladder, and prostate cancers. The unmet treatment needs for patients with these malignancies translated into ripe opportunities for studying novel agents and treatment approaches in early-phase trials.

Over the years, Lara’s firsthand role in the evolution of GU oncology has only made him more passionate about continuing the field’s momentum.

“When I started out, we had 2 crummy drugs that were available, but now there’s a playbook that’s a lot more expansive, and each of the choices has been shown to improve outcomes [and provide] longer life, longer remissions, and bigger or more dramatic responses,” he explained.

Due to these developments, Lara’s optimism has materialized into tangible treatment improvements, and he believes cure is on the horizon for many patients with historically incurable diseases.

Carving Out Time for Family and Fun

Many of Lara’s personal and professional accomplishments are realized in his mother, who was diagnosed with stage IV kidney cancer approximately 4 years ago. She is the first person he thinks of when reflecting on how far the oncology field has come since the “downer” days of ineffective therapies. He credits biomedical research as the reason his mother is alive today and marvels at the long-term efficacy of immunotherapy that he has personally seen improve lives.

“I see a lot of people with metastatic kidney cancer, and it’s just astounding that my own mother gets diagnosed with it in her 80s, and she’s a survivor…benefiting from the agents and the treatments that have revolutionized kidney cancer for many people,” he shared.

Today, Lara, his mother, and all 7 of his siblings live within a short drive of each other. “

We’re still tight knit after a few decades of being shuttled over from the Philippines to here,” he remarked.

Beyond his career, Lara first and foremost identifies as a husband and father. “My wife…well, she puts up with me,” Lara joked. “She is my best friend; nothing would have been possible without her.” He and Elizabeth recently celebrated their 29th wedding anniversary.

Lara’s oldest son, Matthew, is an internal medicine resident at his father’s home turf of UC Davis, where he has participated in cancer research. Lara’s youngest son Joshua is a software engineer based in New York City.

In his free time, Lara enjoys taking walks with his family and indulging his creative side by painting landscapes and portraits. One of his most frequent portrait subjects is the family dog, Mocha. Lara’s natural artistry lends itself well to his accomplishments beyond and within the clinic.

“When you’re in a career in GU oncology and you’re trying to discover new approaches or develop new strategies for a patient who’s progressing on their current treatment, it requires a bit of discipline and creativity to come up with a new treatment, a new hypothesis,” Lara said of the intersections between his career and his creative endeavors. “That same thinking process goes into: Where do I put my marks when painting a landscape and make them look intentional? The same goes for being a cancer center director. When you’re trying to…decide on which priority to advance or promote, it may be the same portion of the brain that operates when you’re deciding: What color do I place in this position vs that position on a canvas?”

Leading With Everyday Optimism and Gratitude

One of Lara’s most widespread pieces of advice—for patients, his family, and even himself—is to “cherish every moment.” Throughout his career, he has learned that the unpredictable changes that life brings make every moment meaningful and worth being fully present in.

In GU oncology, what was fascinating to me...was it required, even back then, frequent and robust interactions with other specialties; these malignancies are best approached with a team.

However, his grounded optimism can be best summarized by a quote he heard every Sunday fromhost Casey Kasem at the end of the American Top 40 radio show that he listened to during his stint as a music columnist: “Keep your feet on the ground and keep reaching for the stars.” These are the words he tells all his patients who are worried about their disease outcomes. Lara knows the importance of setting realistic expectations in this evolving field. But overall, he has also seen and contributed to treatment advances that exemplify the value of keeping an open mind. He also advises his mentees: “but most of all: be kind, always.”

“The work that the field has done has paid off and is paying off. I’m even more optimistic about the future.”

References

1. Lara PN Jr, Higdon R, Lim N, et al. Prospective evaluation of cancer clinical trial accrual patterns: identifying potential barriers to enrollment. J Clin Oncol. 2001;19(6):1728-1733. doi:10.1200/JCO.2001.19.6.1728
2. Umutyan A, Chiechi C, Beckett LA, et al. Overcoming barriers to cancer clinical trial accrual: impact of a mass media campaign. Cancer. 2008;112(1):212-219. doi:10.1002/cncr.23170
3. Pal SK, Tangen C, Thompson IM Jr, et al. A comparison of sunitinib with cabozantinib, crizotinib, and savolitinib for treatment of advanced papillary renal cell carcinoma: a randomised, open-label, phase 2 trial. Lancet. 2021;397(10275):695-703. doi:10.1016/ S0140-6736(21)00152-5
4. Ryan CW, Tangen CM, Heath EI, et al. Adjuvant everolimus after surgery for renal cell carcinoma (EVEREST): a doubleblind, placebo-controlled, randomised, phase 3 trial. Lancet. 2023;402(10407):1043-1051. doi:10.1016/ S0140-6736(23)00913-3
5. Agarwal N, Tangen C, Hussain MHA, et al. SWOG S1216: a phase III randomized trial comparing androgen deprivation therapy (ADT) plus TAK-700 with ADT plus bicalutamide in patients (pts) with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC) (NCT01809691). J Clin Oncol. 2021;39(suppl 15):5001. doi:10.1200/JCO.2021.39.15_suppl.5001
6. Lara PN Jr, Mayerson E, Gertz E, et al. Markers of bone metabolism and overall survival in men with bone-metastatic hormone sensitive prostate cancer (HSPC): a subset analysis of SWOG S1216, a phase III trial of androgen deprivation with or without orteronel. Prostate Cancer Prostatic Dis. 2024;27(3):566-570. doi:10.1038/s41391-024-00813-3