Cancer Through My Eyes – Episode 9: Charles J Milrod

In this ninth episode of Cancer Through My Eyes, we feature a physician-scientist whose work bridges clinical care and translational research in hematologic malignancies. Dr. Charles J. Milrod is a Hematology/Oncology Fellow at Brown University where his research focus is on T-cell exhaustion in lymphomas. Through this series, we continue to explore the stories behind today’s most passionate oncology leaders – what drives them, what challenges them, and what gives their work meaning.

Dr. Charles J Milrod’s Story

From the beginning, Dr. Milrod was drawn to high-stakes challenges where science and human experience collide. Hematologic oncology—particularly lymphomas—offered a unique balance of curative potential and nuanced care, where medicine is both an art and a science. His fascination took root in these dualities: aggressive lymphomas with hopes of cure, and indolent ones demanding a patient-centered, personalized approach.

At Brown University, his research aims to optimize immunotherapy through a better understanding of T-cell exhaustion—how and when immune cells lose their cancer-fighting abilities. Dr. Milrod and his team are focused on mapping the timing of key immune markers, like T-cell subsets and cytokines, during treatment. His goal? To craft evidence-based dosing schedules that are both powerful and tolerable, increasing cancer control while minimizing toxicity.

Q/A with Dr. Milrod

1․ What initially drew you to hematology/oncology—and especially lymphomas—and how did that early fascination shape your path into medical oncology?

Hem/onc as a field is high/stakes- our day-to-day job is tackling problems that have life-and-death implications. I loved the idea of being part of advancing science that could directly change patient outcomes. With lymphomas, you get this fascinating range: aggressive lymphomas where we have a real shot at curing patients, and indolent lymphomas where medicine becomes more of an art. We’re constantly asking ourselves: Who needs treatment now? Who can wait? What outcomes actually matter to patients? That blend of high stakes, scientific advancement, and personalized care is what pulled me into medical oncology—and honestly, I haven’t looked back since!

2. Your translational research at Brown University zeroes in on T-cell exhaustion as a mechanism of immunotherapy resistance. Could you share a pivotal moment (in the lab or clinic) that ignited your commitment to this specialized area?

My interest has always been patient-centered outcomes—specifically, whether we’re helping patients live longer or better. T-cell exhaustion was not immediately obvious to me as a means to a patient-centered outcome, but my research has really focused on connecting T-cell exhaustion to changing how we treat patients for the better.

Early in my fellowship, I came across a pivotal paper by Philipp et al. showing that continuous bispecific antibody administration led to T-cell exhaustion, while treatment-free intervals restored T-cell cytotoxicity (link here). In lymphoma, bispecifics are dosed intermittently rather than continuously, and this hadn’t yet been explored. I immediately saw an opportunity: could incorporating treatment-free intervals actually increase cytotoxicity in lymphoma patients? Less drug could mean fewer side effects, and increased cytotoxicity could mean better cancer control.

Because this foundational work hadn’t been done yet, I reached out to colleagues, assembled a collaborative team, and we started investigating it together. With support from ASCO’s Young Investigator Award, we’re now studying the timing of T-cell exhaustion during intermittent bispecific treatment, aiming to lay the groundwork for future trials that strategically incorporate treatment-free intervals.

3. Balancing a Hematology/Oncology Fellowship, patient care, and clinical trials can be demanding. How do you manage the interplay between day-to-day clinical responsibilities and leading research projects?

It’s challenging—but very worthwhile. My clinical work has given me perspective on patient preferences and the outcomes that truly matter to them. I carry those insights directly into clinical trials and research projects. Patient interactions help shape meaningful research questions, and research outcomes, in turn, enhance patient care. This perspective keeps my work focused on what patients value most.

5. Many aspiring oncologists feel overwhelmed by rapidly evolving fields like immunotherapy. What key lessons have you learned about staying current and determining where to invest research efforts?

It’s true—the pace can feel overwhelming. One of the best lessons I’ve learned is to focus on questions that have value regardless of outcome. If a negative result would still meaningfully inform clinical practice or patient care, then it’s a good question. Staying current means continually revisiting what matters most to patients and clinicians, reading broadly but critically, and investing effort in research that’s designed to move the field forward no matter what you find.

6. T-cell exhaustion markers and cytokines can feel highly technical to newcomers. How would you explain their importance, and why should young oncologists pay attention to these areas in patient treatment protocols?

These markers can definitely seem technical at first, and I find they feel more intuitive when you think about how markers of activation or inhibition can directly impact how we design cancer-directed therapy regimens. T-cell exhaustion markers and cytokines tell us about the immune system’s readiness to fight cancer. For instance, the treatment-free interval study we discussed earlier (Philipp et al.) shows that continuous exposure to certain immunotherapies can exhaust T-cells—but giving the immune system breaks can restore its ability to effectively target cancer cells.

For young oncologists, these markers may translate into today’s research breakthroughs and serve as the foundation for future clinical practice. Understanding T-cell biology helps us design smarter treatment schedules, potentially improving both outcomes and quality of life for our patients.

6. In your view, what does it take to design a clinical trial that not only advances science but also prioritizes patient experience and safety?

Incorporating patient preferences, prioritizing quality of life, and minimizing adverse effects isn’t just complementary—at it’s core, this is exactly the intention of improving outcomes with cancer-directed therapy. A successful trial begins by asking meaningful questions: What matters most to patients? How do we improve survival outcomes and quality of life at the same time? Effective trial design involves patients early in the process and measures outcomes in a way that can reflect their real-world experiences. Keeping patients at the center makes trials more relevant, results more actionable, and ultimately leads to better patient care.

7. Collaboration is crucial in translational research. What advice would you give to early-career oncologists about building effective teams and nurturing cross-disciplinary partnerships?

Read broadly, talk to everyone, and find your niche—this is key to successful collaboration. Remember, you bring value. Whether your strength is clinical experience or you’re closer to basic science from your preclinical training, identify your expertise and leverage it. Effective collaboration starts when you clearly communicate your unique strengths and show how you can add value to a team. Building great partnerships is about bringing complementary skills together, so embrace your role confidently and seek out colleagues whose strengths align with your gaps.

8. As someone at the forefront of immunotherapy for blood cancers, what message or guiding principle would you share with those just beginning their own journey in oncology?

My guiding principle would be this: Keep patients at the center of everything you do. Oncology—and especially immunotherapy—is rapidly changing, but meaningful progress comes from understanding what’s important to patients and addressing those needs directly through your research. Invest your energy in questions that matter regardless of outcome, collaborate generously, and remember that the ultimate goal isn’t just scientific advancement—it’s improving lives.

As Cancer Through My Eyes continues, Dr. Milrod’s journey is a testament to the future of oncology – where thoughtful research meets intentional care.

Through his work in the lab and at the bedside, Dr. Milrod is helping redefine how we deliver immunotherapy, asking better questions, and designing better tools for tomorrow’s cancer care. His story reminds us that behind every innovation is a human drive to ease suffering, prolong life, and do better—for the science, and for the souls we serve.

Got a question or someone we should feature next? Reach out on social media—we’d love to hear from you.

Stay tuned for more voices that shape the heart of cancer care.

By Semiramida Nina Markosyan, HBSc.

Read and watch more dialogues and series by OncoDaily.

Episode 1 with Dr. Hadeel Hassan – Cancer Through My Eyes

Episode 2 with Ziad Abuhelwa – Cancer Through My Eyes 

Episode 3 with Jasmin Hundal – Cancer Through My Eyes

Episode 4 with Angelo Pirozzi – Cancer Through My Eyes

Episode 5 with Dr. Soirindhri Banerjee – Cancer Through My Eyes

Episode 6 with Alexis LeVee – Cancer Through My Eyes

Episode 7 with Renée Maria Saliby – Cancer Through My Eyes

Episode 8 with Michael Serzan – Cancer Through My Eyes