Alex Herrera, MD, Finds a Path From the Baseball Fields of Miami to a Leadership Role at City of Hope
Lymphoma expert Alex Herrera, MD, was born in Miami; his parents were just 19 years old when he was born. Dr. Herrera’s father was born in Puerto Rico to Cuban and Ecuadorian parents. His mother was born in Cuba and came to the United States via Operation Peter Pan, the clandestine program that orchestrated the exodus of more than 14,000 minors from Cuba between 1960 and 1962.
Dr. Herrera’s mother was a cocktail waitress before he was born and later worked as a paralegal at the U.S. Customs Service. His father did double duty as a car salesman and a bartender at the Mutiny Hotel, the infamous Miami hotspot where Central Intelligence Agency operatives partied side by side with notorious drug traffickers, celebrities, and politicians. “If you have seen the cult film Cocaine Cowboys about Miami in the 1980s, you might have some insight into what our house was like when I was growing up,” said Dr. Herrera. “My parents ultimately divorced, and my mother raised us on her own.”
As a youth, his safe haven from a hectic homelife was on the baseball diamond. “Like any good Miami Cuban boy, I could swing a baseball bat before I could walk,” he said. “As a kid, I threw myself into sports, baseball especially. That was my happy space. Eventually, I threw myself into my studies as well.”
Disregarding the Naysayers
“During my senior year in high school, I told my guidance counselor that my uncle encouraged me to aim high, so I was going to apply to Princeton University. He tried to dissuade me because no one from my high school had been accepted to Princeton in 40 years. I wasn’t discouraged, so I applied, and to his shock, I was accepted,” said Dr. Herrera.
Dr. Herrera entered Princeton University as a history major, also doing premed work. By then, he’d decided to pursue a career in medicine—quite a leap for someone whose foray into higher education was a first in his family. Princeton was also where he met his future wife, Naomi.
“I was blown away by all of the possibilities emerging in the field of cancer medicine. Right then, I knew I was hooked on oncology.”— Alex Herrera, MD
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When he was readying to apply to medical school, he was met with skeptical resistance similar to what he encountered in high school. “I sat with the premed advisory office and showed them a list of the medical schools I wanted to apply to, my first choice being Harvard, and the lead counselor sort of looked down her nose and told me it would be wise to readjust my expectations and pursue a more realistic path. I was frustrated, to say the least, but I applied to Harvard Medical School and was accepted,” said Dr. Herrera.
He continued: “The year before I entered medical school, I spent a year at the University of California, San Francisco, doing breast cancer clinical research as part of the Doris Duke Charitable Foundation International Clinical Research Fellowship Program. At that time, I was a little vague about what I actually wanted to do in medicine. I knew I wanted to become a doctor and care for patients but had no idea about a specialty. I’d done basic bench research, but I wanted to try clinical research, which ended up to be a formative experience in my career path. It was during this initial clinical research experience that the idea of personalizing cancer treatments first sparked my interest.”
An Inspiring Lecture
Asked about medical school, Dr. Herrera commented: “Harvard was an absolutely terrific experience. I spent a year living in South Africa doing HIV and tuberculosis research. I was taking varied courses in anatomy and physiology, and I distinctly remember taking a chemistry course with a lecture about signaling pathways in cancer; I was blown away by all the possibilities emerging in cancer medicine. Right then, I knew I was hooked on oncology.”
He continued: “During my third year in med school, I participated in a longitudinal program where you follow a patient with cancer throughout their journey. I was paired with a woman who had metastatic ovarian cancer, and we truly hit it off. I went to all of her infusion appointments, sitting with her in the afternoons chatting about life. I even went on home visits to see her, which was a special opportunity to understand the personal challenges of patients with cancer. And it was that experience that solidified my decision to become an oncologist,” said Dr. Herrera.
After attaining his medical degree, Dr. Herrera matched in internal medicine at the Brigham and Women’s Hospital. He initially thought about going into pediatric oncology, but his ultimate choice of specialty offered him the opportunity to work with a wide range of patient ages and genders. “I specialize in lymphoma, particularly in Hodgkin lymphoma. A lot of my patients are young people, in their late teens and early 20s and 30s. I also treat non-Hodgkin lymphoma, where the average age of onset is in the 60s, so I interact with and help a diverse group of people, which is a very rewarding clinical experience,” said Dr. Herrera.
A Valuable Fellowship in Boston
Following his residency at Brigham and Women’s Hospital, Dr. Herrera was accepted for a hematology/oncology fellowship at Dana-Farber Cancer Institute. “During my fellowship, my passion to cure patients with lymphoma and patients receiving stem cell transplants increased. I was fortunate to be paired with two incredible, outstanding mentors who became dear friends, who became dear friends, Drs. Ann LaCasce and the late Francisco Marty, who led me through my first research projects in stem cell transplantation and lymphoma,” he said.
He added: “My first lead-authored paper was published in TheNew England Journal of Medicine, which is an impossibly high bar to set for a career. It was an incredible experience, and I trained with the lymphoma and bone marrow transplant groups at Dana-Farber. Immunotherapy was just coming of age, and PD-1 blockade was really starting to make a splash. We began treating patients with lymphoma with nivolumab and pembrolizumab, and it was remarkable to see these amazing responses, particularly in patients with Hodgkin lymphoma.”
The West Coast Beckons
Asked about his subsequent transition to the West Coast, Dr. Herrera replied: “At the time, my wife was training as an oceanographer and was finishing her postdoctoral studies, so she applied to tenure-track faculty jobs around the country. There were only four jobs in the specific area that she wanted to study, and we were so lucky that she landed a job in Los Angeles at the University of Southern California. I moved my 4-month old son and my wife to Los Angeles in the middle of winter and flew back to Boston during a snow storm for the last year and a half of my fellowship.”
He continued: “I flew back and forth to LA every other week for about 2 or 3 months and realized it wasn’t going to work. So, I talked to my mentors in Boston, and based on my interest in lymphoma and stem cell transplant, it was clear that City of Hope was the place I should be. I met with Dr. Stephen Forman and was fortunate enough to be able to move to LA in the summer of 2014 to do a bone marrow transplant fellowship,” Dr. Herrera said.
When I arrived at City of Hope, I was encouraged to run with my ideas. I was incredibly fortunate to find an institution that would give a young clinician-scientist such incredible support. I came into oncology at an exciting time, when immunotherapy was just gathering steam, and I got to City of Hope just as the institution was entering a maor growth period. In the last decade, we have quadrupled in patient volume, and our research and clinical trial productivity have skyrocketed.”
Dr. Herrera noted that his clinical and research interests have focused on immunotherapy and hematopoietic stem cell transplantation in patients with lymphoma. He is the principal investigator of more than 30 clinical trials evaluating novel agents for the treatment of Hodgkin or non-Hodgkin lymphomas, including 12 investigator-initiated trials. “I also study biomarkers of response and outcome in patients with lymphoma treated with immunotherapies or hematopoietic stem cell transplantation, with the goal of designing biomarker-based clinical trials to improve outcomes and personalize lymphoma treatment,” he said.
A Fateful Trip
In 2019, just as his career was in full bloom, Dr. Herrera, an avid outdoorsman, went on a ski trip that took a near-fatal turn. “I remember it had been a great day of skiing, and I was taking the last run of the last day, figuring after this run, I’ll be back at the lodge drinking hot chocolate. Halfway down the hill, I had to swerve to avoid a downed skier; I lost control and went headlong into an ice wall. I was wearing a helmet, but I hit the unprotected temple. I saw stars and knew immediately that I’d been concussed. (As a kid, I had had concussions playing sports.) I went back home the next day, and 2 days after my concussion, I flew to Italy to give a talk. Jet lag is not great for concussions, I can tell you now from experience. But instead of slowing down, I was grinding harder than ever—lecturing, seeing patients, and running clinical trials,” said Dr. Herrera.
Although still plagued with concussion symptoms, for a while he began to feel slightly better. Then he did an interview, and the long exposure to bright lighting triggered a terrible response. “My brain just shut down. I couldn’t deal with lights or sounds. My kids came in to wake me in the morning, and I was in a fetal position, paralyzed by noise. After that, I had a pretty rapid downward spiral into postconcussive syndrome. I had to start stepping back from work and wearing ear plugs inside my own house. I signed over all my studies and cancelled my talks at the upcoming 2019 American Society of Hematology (ASH) meeting. I was depressed and wasn’t sure I’d ever work again. It was an awful feeling. I think the most important lesson I learned in that dark time—which I think is vital for all of us—is to learn how to fail,” said Dr. Herrera.
“I’ve worked extremely hard in my life, but some really good people have mentored me during important and difficult times. We all need that.”— Alex Herrera, MD
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Bent on reviving himself and his career, Dr. Herrera began practicing mindfulness meditation and other interventions to help regain his cognitive and emotional clarity. “I underwent every therapy we learn about in psych rotations. I wanted to get my family and my career back. It was a humbling yet positive experience.”
A full year later, on March 1, 2020, Dr. Herrera went back to work. “It was right around ASH 2020 abstract submission time that I really started to feel better. We submitted my first investigator-initiated trial as an abstract to ASH, which showed promising results. When I first came into this field, there were early studies showing that immunotherapy and targeted agents had enormous potential in Hodgkin lymphoma. Now, 10 or so years later, we’re seeing how these immunotherapies can lead to more cures and long-term remissions in these patients. So, it’s been incredibly rewarding, and I look forward to being part of this very bright future in the treatment of hematologic malignancies,” said Dr. Herrera.
How does a super-busy oncology leader decompress: “I spend a lot of time with my family. We travel and hike together and just enjoy each other’s company. My sons are 7 and 9, and we play sports together. This is a time in my life when my kids’ sports schedules basically occupy all my free time. I coach their Little League baseball team, which to me is a great pleasure, helping and mentoring their teammates as well.”
He added: “I’ve worked extremely hard in my life, but some really good people have mentored me during important and difficult times. We all need that. And that’s what I try to do, in turn, whether it be as a mentor at City of Hope or a coach on the baseball field.”
DISCLOSURE: Dr. Herrera reported no conflicts of interest.