Lung Cancer Expert Julie R. Brahmer, MD, MSc, Was an Early Believer in Immunotherapy—and Still Is

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Lung cancer specialist Julie R. Brahmer, MD, MSc, comes from a long line of Midwest farmers who still run a family operation. “I’m originally from what I would call the middle of nowhere in Nebraska. My father is a sixth-generation farmer, and my mother is a nurse. I was inclined toward medicine at an early age, and my mother told me that if I did go into medicine, I should become a doctor. My grandfather died of non-Hodgkin lymphoma when I was a senior in high school, which furthered my interest in becoming a ­doctor,” said Dr. Brahmer.

Julie R. Brahmer, MD, MSc

Julie R. Brahmer, MD, MSc

After graduating high school, Dr. Brahmer entered Creighton University. “My plan was to continue on to medical school, but I did have a backup, which was to get a PhD in chemistry. However, I was very lucky in that I was accepted to the University of Nebraska Medical Center. During medical school, I had an opportunity to conduct some research under ASCO Past President, Julie Vose, MD, MBA, which was my first exposure to oncology in the medical school setting,” Dr. Brahmer added.

After receiving her medical degree, Dr. Brahmer began her internship and residency program at the University of Utah, Salt Lake City. “During my residency, there were several terrific physicians who continued to spark my interest in oncology, particularly John Ward, MD, who is a professor and breast cancer specialist. I served as chief medical resident from 1996 to 1997. I applied for fellowships at multiple institutions; then, Ross Donehower, MD, Director of the Medical Oncology/Hematology Fellowship Training Program at Johns Hopkins, offered me a fellowship position. I accepted it and have been here ever since,” shared Dr. Brahmer.

Loyal to Johns Hopkins

During her fellowship, Dr. Brahmer was initially interested in lung cancer and worked on research projects with David Ettinger, MD. “Dr. Ettinger was a huge mentor who opened the door for me, so to speak. At the time, he was the only lung cancer specialist at Hopkins and needed help seeing patients. So, with the help of philanthropy, I was hired, becoming the second thoracic oncologist in the department,” noted Dr. Brahmer.

During this period, Dr. Brahmer went back to school and received a master’s degree in clinical trial design from Johns Hopkins School of Public Health. “During my tenure here, I’ve entertained the idea of moving to another institution, but I’ve stayed because of the great colleagues and support system, and also because of the institution’s rich history in science and breakthrough developments. I can walk down the hall and speak to world-class experts on any disease,” said Dr. Brahmer.

An Early Believer in Immunotherapy

Asked about her current work in immunology, Dr. Brahmer commented: “My route to where I am today was a little prolonged. I began as a phase I trialist in cancer drug development. In the mid 2000s, I was offered to do a trial on an immune checkpoint inhibitor drug called MDX-1106, now known as nivolumab. Ever since doing first-in-human trials, I’ve been interested in immunotherapy for lung cancer. Although it wasn’t my initial interest at Johns Hopkins, it has grown into the major part of my current career,” she noted. “It’s important to remember at that time, immunotherapy in cancer had not yet caught on, and I think I was chosen to lead the trial because of my previous experience in phase I trial design.”

“I’ve stayed [at Johns Hopkins] because of the great colleagues and support system…. I can walk down the hall and speak to world-class experts on any disease.”
— Julie R. Brahmer, MD, MSc

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Dr. Brahmer continued: “My first oral presentation was at the 2008 ASCO Annual Meeting, where I reported the results of the nivolumab phase I trial. There might have been 20 people in the audience at best, and you know the size of the ballrooms where the presentations take place. The audience was made up of people who had typically done research regarding immunotherapies in melanoma or kidney cancer, so they were among the pioneers in immunotherapy. However, in a follow-up trial, when we presented the lung cancer data, some of my mentors at other institutions approached me, basically saying it was just one small trial and did not prove the value of immunotherapy. Of course, immunotherapy ultimately changed the way we look at lung cancers and other malignancies. I’m glad I was there at the beginning, but more important, I’m excited about the promise these new agents will have for our patients with cancer. That’s why we do this.”

Value of Mentoring

Dr. Brahmer has a busy and varied workload, spending 2 long days in the clinic, and the rest of her time is devoted to administrative work. “I’m Director of our thoracic oncology group and Co-Director of our cancer immunology National Cancer Institute–sponsored program. So, I also spend a lot of time mentoring other folks within our thoracic oncology group as well as newly arrived fellows. I still direct the thoracic oncology research program, with the help of Patrick Forde, MBBCh, as it’s important for me to keep my hand in trial work. Naturally, my week includes plenty of meetings with our tumor board and the clinical trial research group and basic scientists to discuss what we need to bring into trial next. If asked what my most valued task is at this point in my career, I would say mentoring our faculty and fellows to help their research careers blossom.”

Asked what advice she would give bright young medical students pondering a career in oncology, Dr. Brahmer replied enthusiastically: “I’d say right off that oncology is the best career choice possible. But more than anything, it’s vital to do what jazzes you when you get up in the morning. I would also caution them to understand the responsibility of oncology, the long hours caring for very sick people who look to you to help them through some of the darkest days of their lives.”

Research Interests

Dr. Brahmer’s current research interests include leading early-phase immunotherapy trials of anti–programmed cell death protein 1 antibodies, international phase III studies of immunotherapies in lung cancer, and investigator-initiated trials evaluating epigenetic therapies in combination with immunotherapies. She is a member of ASCO, the Eastern Cooperative Oncology Group Thoracic Committee, and co-leads the immune therapy toxicity management guidelines for ASCO. She is very active in lung cancer patient advocacy groups such as LUNGevity, the Lung Cancer Research Foundation of America, and the Lung Cancer Research Foundation. In April, she was awarded the LUNGevity Face of Hope Award for her work to improve the lives of patients with lung cancer.

Family and Friends

When the discussion turned to physician burnout, Dr. Brahmer said: “First off, I spend as much time with my family as possible. My daughter is just 10 years old, so you can imagine all the school and extracurricular activities we’re involved in. At night, we go around the dinner table and share our favorite part of the day, our worst part, and the funniest part. That brings joy to me.”

When asked how she unwinds at the end of the day, she mentioned her time behind the wheel of her car. “My work is challenging, and my one time alone to decompress is my 35-minute drive home from Hopkins. Fortunately, my friends all know my schedule and when to expect a call; it’s my time to destress. My family all still live in Nebraska, and calling each other to check in was a ritual when I was growing up. It still is, and driving home is when I reconnect with them. Family keeps things in perspective. My father is still farming, and it’s a great place to visit and get away from it all, out in the middle of nowhere.” 

DISCLOSURE: Dr. Brahmer reported no conflicts of interest.