But that wasn’t always the plan. When Tawbi began medical school, he wanted to become a gastroenterologist. It wasn’t until his oncology rotation during residency that he decided to specialize in treating cancer.
“I loved it,” he says. “The patients were amazing. I felt like we were partners, working together.”
Partnering with patients facing brain metastases
Today, Tawbi, a melanoma medical oncologist, partners with patients who have cancer that metastasized or spread to the brain. Along with neurosurgeon Frederick Lang, M.D., and radiation oncologist Jing Li, M.D., Ph.D., he serves as a clinical co-director of the clinic.
The clinic is open to anyone diagnosed with brain metastasis. These tumors are notoriously difficult to treat, and because of their location, they can come with symptoms ranging from mood impacts to loss of mobility. Patients with brain metastases have commonly been excluded from clinical trials for a few reasons. Brain tissue is protected by what’s called the blood-brain barrier. It’s designed to minimize inflammation, which protects the brain and blocks drugs from entering it. But at the same time, this blood-brain barrier can also protect brain tumors and make them more resistant to treatment. The Food and Drug Administration (FDA) has particularly high standards for drugs that impact the brain. Researchers say that’s resulted in pharmaceutical companies steering away from developing drugs that could treat brain metastasis. But that’s starting to change.
“When we hit that part that’s the darkest and hardest, the parts where not enough light has been cast yet, we tend to give up. Cancer researchers have been doing that with brain metastases for far too long,” Tawbi says. “This clinic is our way of remedying that.”
His patients are his motivation.
“I try to put myself in the patient’s shoes: When someone tells you there is cancer growing in your brain and the only way to manage it is to cut it out or radiate your brain, that must sound scary,” Tawbi says. “We’ve had great success in treating melanoma patients with immunotherapy, but I want that for all of my patients, especially the ones with brain metastases.”
A change in career direction
While Tawbi wasn’t drawn to oncology from the start, he was always interested in science and research as a kid growing up in Lebanon.
“I was always the nerdiest kid,” he says. “From the time I was little, I knew I wanted to be an expert in just one thing, even though I didn’t know what that one thing would be.”
He eventually went to medical school in Lebanon and came to the U.S. for his residency. During this time, he became interested in drug development. He could often be found following around the pharmacists, trying to learn as much as he could. He loved the way that scientific discovery and oncology care worked together to make an impact for patients.
He decided to specialize in melanoma treatment and started a lab focused on melanoma research, but he was asked to start a sarcoma program during the first year of his fellowship.
“I had to figure out how to start something from scratch, and, because sarcoma is rare, I had to think about how to work with rare populations and bring clinical trials to them,” he says.
Tawbi led a clinical trial bringing immunotherapy to sarcoma patients, then another one treating melanoma patients with brain metastasis, helping him develop expertise in this area. He started collaborating with Michael Davies, M.D., Ph.D., now MD Anderson Melanoma Medical Oncology chair. It became clear to MD Anderson’s melanoma team that Tawbi, a clinician and researcher with experience in building programs and treating rare diseases, was just what they were missing, and they recruited him to join.
Leaving behind the sarcoma program he had started wasn’t easy for Tawbi, but he felt his career pulling him in a different direction: one that led him to treat melanoma at MD Anderson.
Establishing MD Anderson’s Brain Metastasis Clinic through STRIDE
MD Anderson had already launched a steering committee focused on treating brain metastases when Tawbi arrived in 2015 and he soon joined the group. “We needed ways to do everything to help patients with brain metastases: find new drugs, find new genetic targets, understand what’s different about brain tumors biology, develop clinical trials and provide our patients with the best possible multidisciplinary care,” he says. “The answer was the Brain Metastasis Clinic.”
In 2019, MD Anderson opened the clinic, providing more convenient and efficient care for patients and more closely uniting them with the cancer center’s research in this area.
Each patient seen in the clinic receives a personalized treatment plan developed by a multidisciplinary team of specialists who factor in the tumor’s biology, imaging, genetics and the patient’s priorities. Patients have access to clinical trials, advanced radiation therapy and imaging techniques, and surgical innovations, all to maximize survival and maintain quality of life.
The clinic pulls together experts from across the organization.
“Most hospitals invest in a department or a program, but we looked at a problem and invested in specific and bold solutions. We’re doing science by setting up the right environment,” Tawbi says. “This clinic could have only started at MD Anderson.”
Working across silos isn’t always easy to do at a place as large as MD Anderson, but a program now called STRIDE made it possible. STRIDE, which stands for Strategic Research Initiative Development, supports projects with high potential to increase research opportunities and improve patient care. By supporting teams to identify gaps and create processes or find funding and bring together teams regardless of the type of cancer, this helps researchers make their ideas become a reality. Led by executive director Liz Burton and Genomic Medicine chair Andrew Futreal, Ph.D., STRIDE has launched five successful programs since its start in 2017. It is helping several more get off the ground.
“This kind of guidance and mentorship is unique to MD Anderson,” Tawbi says.
Looking toward the future for brain metastasis patients
The clinic recently celebrated its fourth anniversary and has served over 1,000 patients. In May, it received a $5 million gift from Jeffrey McDougall, a member of the MD Anderson Cancer Center Board of Visitors, on behalf of his family. The gift honors his late son, Andrew, who developed brain metastases after he was diagnosed with stage IV melanoma in 2018. The gift, which will be matched through additional fundraising efforts to reach $10 million, integrates the brain metastasis clinic and research program to discover, evaluate and deploy new treatment options for patients facing brain metastases.
Historically, brain metastases have been treated with surgery and radiation therapy, or some combination of the two. Treatment can leave patients dealing with significant side effects, and it usually extends their lives, but may not offer a true cure. Through the clinic, MD Anderson researchers are now focused on designing drugs against brain metastases and testing them in combination with other therapies in clinical trials. 14 open clinical trials are associated with the clinic. For now, these trials focus on specific cancer types, but they hope to soon be open to all patients with brain metastases, regardless of where the primary tumor started.
“Our vision is to dramatically expand the clinic’s efforts to become the nation’s most influential program in brain metastasis care,” Tawbi says. “If I leave any kind of lasting legacy, I want it to be an impact on truly helping patients with brain metastases.”