Exploring the Intersection of Neurosurgery and Immunotherapy: A Conversation with Dr. Bryan Choi

Interview by Tianna Tout-Puissant

Dr. Bryan Choi, an attending neurosurgeon, specializes in surgical care for patients with benign and malignant brain tumors. He graduated summa cum laude from Harvard College and earned both MD and PhD degrees at Duke University School of Medicine, focusing on tumor immunology. During his neurosurgery residency at Massachusetts General Hospital, Dr. Choi pursued a postdoctoral fellowship, concentrating on CAR T-cell therapies for cancer. He has a broad publication record, holds several patents, and has delivered international lectures on immune-based treatments for brain tumors. As a member of the faculty of the MGH Brain Tumor Center and Harvard Medical School, he is actively engaged in clinical practice and leads a research laboratory with the goal of developing the next generation of cell therapies and conducting clinical trials in neuro-oncology.

Tianna Tout-Puissant (TT): Can you provide an introduction of your background and interest in neurosurgery and research? What led you to specialize in surgical care for patients with benign and malignant brain tumors?

Dr. Bryan Choi (BC): I am a neurosurgeon and within neurosurgery there are many different specialties. My specialty, or what I focus on, is caring for patients with brain tumors. In addition to taking care of these patients in the hospital, I also lead a laboratory that is focused on developing immunotherapies for brain tumors that we otherwise do not have good treatments for.

TT: In your experience as a neurosurgeon, how often do you see cases that demonstrate the impact of tumor removal on a human personality? Can you explain this process?

BC: I think the difficulty with cancers that are in the brain, as opposed to other parts of the body, is the brain has functions that if affected minimally or irritated during the course of surgery, can heavily affect a function, which is called eloquence. When we are operating in and around eloquent portions of the brain, we take great care to minimize damage to those areas. That is part of what neurosurgery trains you to do, to balance the risks and the benefits. For example, when a tumor or lesion is close to an area of the brain that is responsible for language production or comprehension, we will often do those surgeries while the patient is awake and speaking to us. This also allows us to actively understand where these sensitive areas are and avoid injuring them.

TT: What was your first experience performing an operation with an awake patient like?

BC: Every neurosurgeon has that moment where they saw their first case in the OR in surgery, and those were the cases that interested me most during my training and attracted me to the field. Now, that is what I do for a living. Overtime, you get more used to carrying out the surgeries while understanding the sensitive issues surrounding those approaching tumors in these regions.

TT: Are there any special cases in all your experiences that stand out to you that you would like to share?

BC: I think every patient is special and every patient is unique. People's journeys with cancer, particularly in the brain, bring a lot of dimensions that are unique for every patient. That is part of the reason why I am attracted to the field is because there are surprises for every case. Tumor surgery more than any type of surgery in the brain always allows me to learn something new from every case.

TT: You dedicate a considerable amount of time operating on patients, but you also spend numerous hours on research to develop cell therapies and clinical trials, as well as lecturing internationally on immune-based treatments for brain tumors. How important is it to balance hands-on patient care and the progression of your research? What are some difficulties you face?

BC: It is challenging to balance a clinical career with a research career, but I think it is also extremely rewarding to be able to do both. One aspect of my experience in my job influences the other. We take care of patients and learn a lot about the specific challenges of certain diseases that we can then use to inform the decisions that we make in the laboratory. Likewise, the things that we create and develop in the laboratory go from the bench to the bedside to help patients. My work in the lab is primarily focused on translational research or developing new therapies for these patients, which allows for quite a bit of crossover.

TT: What challenges do you face implementing your research into clinical trials? How are these trials accepted in the United States healthcare system?

BC: For anything that you develop in the laboratory that you hope to get into patients to help them or to kind of change the natural history of their disease, there are a lot of regulatory bodies, both institutional and federal, that you have to work with very closely in order to translate these things. It is a process, but it is designed to propel innovation as well. We work hand in hand to make these things happen.

TT: Do you see inequities in patient care or disparities amongst different groups of people when it comes to performing a surgery or a person’s ability to access or afford a clinical trial?

BC: Yeah. I think there are still inequities that are across all aspects of medicine, not only in clinical trials, but even access to everyday care. Part of my research is focused on understanding those inequities, so we can better address them.

TT: Lastly, are there any other insights you would like to share related to advancements in cancer treatments, issues of health policy in your field, or neurosurgery more broadly?

BC: What we are seeing now is really an explosion. We are basically living in an age of immunotherapy. In previous generations, we have not actually been able to realize that dream of redirecting the immune system to target cancer, but more than ever, a lot of these new therapies are being approved for different indications. Over the next decade, I think we are going to be seeing continued advances in the field. It is an exciting time to be a part of that research. I am always open to chatting with younger researchers who would be interested in learning more about it.