Dr. Timothy Brown: Advancing GI Cancer Treatment Through Research Excellence

Timothy Brown, MD, MSCE, is an accomplished gastrointestinal oncologist at UT Southwestern Medical Center, where he also serves as the associate program director of the fellowship program. Dr. Brown’s journey into the field of GI oncology was significantly influenced by mentorship and a series of pivotal experiences during his educational and training years. His diverse background, which includes a degree in human nutrition, foods, and exercise from Virginia Tech and advanced training in clinical epidemiology from the University of Pennsylvania, has equipped him with a unique perspective on cancer research and treatment.

In this interview with GI Oncology Now, Dr. Brown describes his professional trajectory, sharing how his early research experiences and influential mentors shaped his career. He discusses the current state of GI oncology research at UT Southwestern, highlighting recent advancements in treatment, and reflects on the challenges of clinical practice and the strategies he employs to balance his demanding professional responsibilities with personal well-being. Dr. Brown’s vision for the future of GI oncology shines through in his commitment to patient care.

Your diverse educational journey took you from earning a degree in human nutrition at Virginia Tech to advanced training and clinical epidemiology during your fellowship. What initially sparked your interest in gastrointestinal oncology and how have these diverse educational experiences influenced your approach to cancer research and treatment?

Dr. Brown: My journey toward gastrointestinal oncology is a long story, but the short of it comes down to just really good mentorship. I was initially interested in pursuing a career in oncology following some research experiences I had as an undergrad at Virginia Tech.

I was fortunate to get into medical school at Penn State, which is in Hershey, Pennsylvania. Early on in my first year I had the opportunity to sit in a lecture from Niraj Gusani, who was a surgical oncologist there at the time, and he was talking about surgical solutions to pancreatic cancer. I thought that the lecture was very interesting. I had not previously been exposed to pancreatic cancer, but it definitely caught my interest. I was fortunate to shadow him in clinic early on in medical school as well to kind of see how he approaches pancreatic cancer from the surgical perspective. Through the remainder of medical school I explored various interests, including in malignant hematology, where I worked in a lab during first year, second year, and part of fourth year.

I also worked with one of my mentors on several neuro-oncology projects. I ultimately ended up coming to UT Southwestern for residency. As a resident, I continue to explore various interests in malignant hematology as well as GI oncology, exploring various types of research, including quality improvement, outcomes, research and even meta research.

When I was a resident and ultimately as a chief resident, I worked with Dr. Shaalan Beg, who remains as volunteer faculty at UT Southwestern, and he was consistently one of my mentors, even if our clinical interests weren’t necessarily aligned early on. From there I went to Penn for my oncology fellowship, and at Penn we have to very early on declare what our clinical interest is going to be. Coming off those experiences with Dr. Beg, I thought it would be interesting to learn more about GI oncology. From there I was fortunate to work with Dr. Thomas Karasic and Dr. Kim Reiss Binder, both of whom have been very influential in my research and clinical interests and both of whom I remain in close contact with.

When it came time to evaluate potential job opportunities, I reflected on all these experiences, and UT Southwestern had an opening for a GI oncologist and came with the bonus opportunity of being the associate program director of the fellowship.

So that’s basically how I ended up back at UT Southwestern, and through my experience and training, I’ve learned a lot about the importance of research; it’s something I’ve always been passionate about.

I’m constantly looking for whether there are opportunities to improve how we care for patients with various GI cancers, including enrollment into clinical trials or evaluating ways to mitigate toxicities, or if there are specific epidemiologic patterns that we should be aware of that might help us choose one treatment or the other.

Your research focuses on early-phase clinical trial design and outcomes research for gastrointestinal malignancies. Can you share some insights into the most promising early-phase clinical trials currently underway at UT Southwestern and how these trials could potentially change the landscape of GI cancer treatment?

Dr. Brown: We’re fortunate to have a robust phase 1 disease-oriented team at UT Southwestern, and we constantly have trials that are in the pipeline. Answering the question about most promising early phases is difficult because the primary endpoint of early phase trials is toxicity.

However, with regards to promising agents in GI cancer, we are seeing a lot of novel targets such as claudin 18.2, novel drugs such as bispecifics or antibody drug conjugates targeting known treatment targets such as HER2, or even novel strategies to target other driver amplifications.

This is some of the work I’ve been involved in thus far. I’m also excited about combining multimodality treatments, such as employing various radiation techniques with new therapies, or evaluating the safety of various surgical interventions in advanced diseases.

In 2023, you received the Conquer Cancer Merit Award for your contributions to GI oncology. What are some of the key advancements or breakthroughs in gastrointestinal cancer treatments you’ve been most excited about recently, and how do you see these developments impacting patient care in the near future?

Dr. Brown: Clinically, I’m seeing mostly upper GI cancers, esophageal and stomach cancers. And I see a little bit of pancreatic cancer as well as liver cancer. In the upper GI space seeing the emergence of FLOT for the preferred treatment for resectable esophageal or GEJ cancer was probably the biggest practice-changing study at ASCO this past year.

We’re looking forward to seeing the manuscript and learning more details about the ESOPEC study. I think that is probably still the biggest practice change that we’re going to see coming out of ASCO this past year.

Similarly, with regards to the HCC space, seeing data to support frontline ipilimumab and nivolumab was very exciting, adding on what will likely be another frontline option for advanced HCC.

Coming down the pipeline, I’m eagerly awaiting outcomes data from the MATTERHORN studies of FLOT with durvalumab in localized gastric and GEJ cancers as well as additional studies targeting claudin in advanced gastric cancers.

What are some of the biggest challenges you’ve encountered in your clinical practice and what strategies or innovations have you found most effective in overcoming these obstacles?

Dr. Brown: When you go from fellowship to being on faculty, you’re exposed to a whole world of things that you are only sort of peripherally aware of. I think coming from my fellowship to being here at UT Southwestern, one of the biggest challenges I faced is learning how to effectively manage the clinic so that I can perform my other duties as well. I found this can be more manageable if I’m intentional with my time in terms of when I’m logging into our EMR for clinical duties, when I’m going to prepare for clinic, and those sorts of activities. The in-basket volume of course is an ongoing challenge, but I found if I I’m very strict about my time saying I’m going to log in early in the morning and in the mid-afternoon, that prevents the creep of the clinical duties into some of my other time.

From a research standpoint, I’m fortunate to have good mentorship at UT Southwestern, and a good community that gives me a leash to explore new ideas, but also rein me in to make sure I’m consistently progressing on projects that we have ongoing.

As an author and researcher, you have contributed significantly to the field. Looking ahead, what do you believe will be the next big innovation in gastrointestinal oncology research, and how do you envision your work contributing to these future advancements?

Dr. Brown: I think GI oncology compared to, say, thoracic oncology was a little bit behind the times in terms of developing personalized therapies. But I think we’re starting to see the emergence of that in our early-phase and even later-phase trials where we’re starting to learn to target specific mutations with either combination therapies or monotherapies that can be effective. GI oncology in general is also very exciting, as we’ve seen the explosion of immunotherapies and the various ways we can use those tools both in the advanced and incurable settings, as well as earlier in curative settings.

I think some big controversies in the field that are coming are if you use immunotherapies in the earlier lines, how do you use them effectively in the advanced settings if patients recur. So in general, I think seeing the development of these personalized therapies and continuing to identify and target effective driver mutations is an exciting area in GI oncology at the moment.

How do you find a healthy balance between the demanding nature of GI oncology and maintaining your personal well-being?

Dr. Brown: GI oncology is an exciting field because the patients can be very sick and they can have a lot of symptoms, and if you are effective at treating the cancer and addressing the symptoms, you can really make an impact on how the patients feel.

That being said, it can also be very demanding for those same reasons. So my best way to find a balance is just having a supportive family and being very intentional with my time, and what I mean is, when I’m working, I’m working, but when it’s outside of work hours I try to disconnect and I try to think very little about work to the extent it is possible.

Being able to decompress in the off-hours definitely makes me more effective during my work hours, and it allows me to avoid burnout. Some of my colleagues can probably attest that I rarely send or respond to emails on nights or on weekends. I try to really separate myself when I know I’m not assigned to be working or responsible for patient care.

Outside of that, I also have a lot of friends and a good community outside of medicine, so I’m able to exercise alternate hobbies and interests, and not just be focused on medicine 24/7.