Brian Till, MD
Dr. Brian Till is both a physician and a cancer researcher who works at Fred Hutch Cancer Center. He balances dual roles as a board-certified medical oncologist who treats patients with lymphomas (cancers of the lymphatic system) and a researcher who develops new CAR T-cell immunotherapies to treat patients with lymphoma. He's also a former cancer patient, providing him with unique insight into patient care and a strong drive to discover better treatments for lymphoma.
Dr. Till holds the following positions:
- Associate Professor, Clinical Research Division, Fred Hutch Cancer Center
- Associate Professor of Medicine, University of Washington School of Medicine
- Attending Physician, Stem Cell Transplant Service, Fred Hutch Cancer Center
- Attending Physician, Immunotherapy Service, Fred Hutch Cancer Center
- Attending Physician, Lymphoma Clinic, Fred Hutch Cancer Center
"The best part of my job is when one of my patients gets a good response to a treatment that I gave them for their lymphoma, or when one of the patients on our clinical trial gets a complete remission after receiving the treatment we developed in my lab. It never gets old for me to compare a patient’s PET-CT scans before and after treatment and see all the lymphoma gone from the post-treatment scan."
— Dr. Till
Dr. Till's Story
As a child growing up in a small city in southern Arizona, Dr. Till held dreams of being an astronaut or a professional baseball player. Neither of his parents worked in STEM fields; his mom was a teacher and his father was the prosecuting attorney for the county in which the family lived. However, in middle school, Dr. Till zeroed in on the idea of becoming a doctor. Later, his own experience with cancer in college would spark an interest in specializing in medical oncology.
Dr. Till followed a traditional route toward a career in medicine, first achieving a Bachelor's of Science in Biology from The Catholic University of America in Washington, DC. As a college freshman, Dr. Till built an important mentoring relationship with a professor when Dr. James Greene accepted him into his lab for a research project, during which he taught Dr. Till the basics of lab research. Dr. Greene then invited Dr. Till to stay in the lab as an undergraduate researcher until he graduated. Next, Dr. Till attended medical school in Chicago, followed by a three year residency in Philadelphia to develop a specialty in Internal Medicine. After that, Dr. Till moved to Seattle for a research fellowship in Medical Oncology at Fred Hutch. During his research fellowship, Dr. Till worked with Dr. Oliver "Ollie" Press, a renowned lymphoma physician-researcher who became a valuable professional role model. Dr. Press helped launch Dr. Till's research specialty of CAR T-cell therapy and helped him navigate through the "tricky transition" of finding a faculty position at the end of his fellowship.
Cancer Paused and Motivated His Journey
During his first semester of college, Dr. Till was given a surprising diagnosis: he had Hodgkin lymphoma, which put his college plans on pause for a year while he underwent treatment. He reflected, “after watching the lumps of cancer melt away with chemotherapy, and later learning that I was cured, I was amazed that cancer could be cured with medicine like that… I wanted to be able to cure other patients the way I had been cured.” Dr. Till's experience as a cancer patient and survivor solidified his burgeoning interest in medicine. He reflected that his cancer experience "really solidified that desire and also pushed me strongly in the direction of being an oncologist, as opposed to some other kind of doctor." As a cancer survivor, Dr. Till brings to his work a unique perspective. He noted that, "having that experience has also been helpful for me to understand a bit more about what patients are going through." He recalled, "even though it was a long time ago, I can still remember what it feels like to get the news that you have cancer, and the uncertainty about the future that comes with that, and I also have a sense of what kinds of side effects people feel from chemotherapy."
Educational Pathway
Dr. Till's educational pathway toward a career as a physician-researcher includes:
- Undergraduate: BS in Biology from The Catholic University of America, Washington, DC
- Medical Degree: MD from the University of Chicago School of Medicine
- Residency: Internal Medicine, Hospital of the University of Pennsylvania
- Fellowship: Medical Oncology, Fred Hutch Cancer Center
Outside of Work
In his free time, family comes first. Dr. Till enjoys spending time with his family, reading books to his two children, or going skiing, walking, or hiking together as a family. He also enjoys homebrewing beer.
A Day in the Life
Between his two roles as a physician-researcher, Dr. Till splits his time with about 75% research and 25% clinical duties. In addition, he also participates in various committees at Fred Hutch, such as the Institutional Biosafety Committee, which reviews new clinical trial protocols involving gene therapy or treatments that involve recombinant DNA or RNA, and addresses any safety concerns. He noted that along with all the benefits of these dual roles, it can be challenging to balance his clinical and administrative demands with his research in his lab. It can also be difficult to find enough time to read articles to stay informed of both clinical literature in lymphoma and scientific literature in immunology.
Research Responsibilities
Dr. Till leads his own research lab at Fred Hutch, where his team works to "develop new immunotherapy-based treatments for lymphoma, and analyze samples from patients treated on immunotherapy studies." They also "developed a chimeric antigen receptor (CAR), which is an artificial T cell receptor that allows us to reprogram the T cells from patients with lymphoma so that the T cells can attack and kill their cancer cells." Dr. Till explained that "we have a clinical trial that is ongoing now testing this treatment, and I spend a lot of my research time working on various aspects of this trial." As part of this clinical trial, he explained, "one thing we are doing is getting tumor biopsy samples from patients before and after treatment on the trial and analyzing them to try to understand why some patients get good responses and others don’t, and also to try to understand why the tumors sometimes come back in patients who had a good response to treatment." As the leader of the lab, Dr. Till meets with the members of his lab once a week and reviews the data from experiments they did the week before, and together they plan out the experiments for the week to come.
Clinical Responsibilities
Dr. Till's clinical duties as a physician include seeing patients with lymphoma in a clinic at Fred Hutch Cancer Center a half-day per week, and attending one month per year on the Immunotherapy Service or Stem Cell Transplant Service. Also, about twice a month he sees patients in consultation who were referred to him from other doctors who think that the patient might be a candidate for immunotherapy such as chimeric antigen receptor (CAR) T cell therapy, or a stem cell transplant. Dr. Till explains that "even though my clinic is only a half day per week, I spend a fair amount of time outside clinic hours preparing for the next clinic, or following up on issues from previous clinics."
The best part of his clinical work? Dr. Till shared that the best part of his job as a medical oncologist is seeing his patients respond well to a treatment he prescribed or that was developed in his lab. He noted that "sometimes patients have a lot of symptoms and feel sick from their lymphomas, and talking to them again after they’ve gotten their first treatment and feel a lot better is really rewarding and gratifying." But there is also the flipside. Dr. Till reflected that a challenging part of this work is "when patients don’t do well, or when I run out of treatment options for them." He explained that this is infrequent, however. "Luckily, since lymphoma is usually a very treatable disease, this situation does not come up as often as it does in other types of cancer, but it can be hard when you don’t have anything else to offer someone when their cancer is growing," he explained. "When it happens, it reminds me how important research is, to try to come up with new and better treatments."
Till Lab Research: Engineering Immune Cells to Fight Cancer
At the Till Lab in the Clinical Research Division of Fred Hutch Cancer Center, Dr. Till and his team are developing immunotherapies to treat lymphoma and testing these new therapies through the clinical trial process. Dr. Till describes their research in more detail below:
"...We developed a CAR (artificial T cell receptor) that re-directs patients’ T cells to be able to attack and kill their lymphomas. It targets a protein called CD20 that sits on the cell membrane of cancer cells. We tested different versions of this CAR for a few years in the lab to try to find the one that would work the best, and then ultimately we chose one and decided to test it in a clinical trial. Fortunately we were able to find a company that was interested in this CAR and was willing to pay for the clinical trial, which is very expensive and something I never would have been able to do with just my grant funding."
"The way it works is that we take some T cells from patients with lymphoma and send them to a special, very sterile, lab at Fred Hutch that makes products for clinical use. In this lab, they use a modified virus called a lentiviral vector that inserts the DNA for the gene encoding the CAR into the genome of the patients’ T cells. The T cells then produce the CAR, which allows them to recognize the lymphoma cells. We grow the cells for about 10 days in the lab until there are many millions of them, and then infuse the cells back into the patients. We have been fortunate to see that the treatment has been working in most of the patients we have tested. We are still working to understand why some patients only get a partial remission and others get a complete remission, and of those with a complete remission, why the lymphoma comes back later in some of them. We are using some cutting-edge tests on the tumor biopsies from these patients to try to understand if there are differences in the biology of their tumors that explain these differences. We are also studying their CAR T-cells to see if there are differences in the T cells from patient to patient that might explain why some do better than others."
To learn more about the special sterile lab mentioned by Dr. Till, check out the Therapeutic Products service at Fred Hutch and read a profile of the facility director, Dr. Otegbeye (will add link to profile here).
Advice for Students
Become well-rounded, take statistics classes, and find good mentors. While Dr. Till acknowledged that it is important to take science classes to prepare for a career in STEM, he advised that "college is also an opportunity to broaden your horizons and become a more well-rounded, informed human being, with classes in philosophy, literature, history, economics, etc." He reflected, "I think it is important to learn about the world and how it works and how to think critically and write and communicate well, and not be completely laser focused on science." He explained, "there will be time in medical school or graduate school to go into depth in the science classes, but you will probably never again get an opportunity to take those classes in the humanities."
Another piece of advice from Dr. Till is to take one or more statistics classes. He advised that students need to "really understand how statistics work—it is an important part of almost any kind of science or medicine you go into."
Finally, Dr. Till stressed the importance of finding good mentors to help you along your educational and career journey. He noted that mentors can "serve as role models, guide you in applying to medical/graduate school programs, inspire you to go in a certain direction with your career, write letters of recommendation for you, and give you guidance and advice about your career and life in general." Just like Dr. Till developed important relationships with mentors in college and during his research fellowship, he noted "it’s extremely difficult to become a researcher at a strong academic institution on your own, and so it is really necessary to find someone who cares about you to help you navigate all the challenges and advocate for you to get to the next level."
"It is exciting when an experiment turns out the way I was hoping and supports a hypothesis I had, especially if it happens over and over enough times that convinces me that it is a true finding. It is fun to get a new idea, design an experiment to test the idea, and then get to see the data from the experiment for the first time, before anyone else in the world knows about it."
— Dr. Till
U.S. Wage Information
According to the 2023 U.S. Bureau of Labor Statistics’ Occupational Employment and Wage Statistics:
- The median wage for physicians in the U.S. is $239,200
- The median wage for medical scientists in the U.S. is $100,890
Additional Resources
Credit: Thank you to Dr. Till for participating in this project. Profile written by Dr. Kristen Clapper Bergsman.