Dr. Michael Morse GI Oncologist

My daughter is five years old. By the time I was her age, I already knew I wanted to be a doctor.

Throughout medical school at Yale and the beginning of my residency at the University of Washington in Seattle, I was interested in cardiology. Then, during the second year of my residency, I spent a month working with a dynamic, well-known medical oncologist. I really liked his approach to the management of cancer and dealing with people with serious illnesses. Medical oncology represented a different way of interacting with people than cardiology, and it had a wealth of scientific opportunities to translate developments in the laboratory into clinical realities. I decided to do a fellowship in medical oncology, and I was impressed with Duke’s program, which offers diverse experiences. When I came to Duke to interview, I was amazed to see that second-year fellows were studying new gene and working on new drugs. I came here in 1993 for a three-year fellowship and have been here ever since.

My clinical specialty is gastrointestinal (GI) oncology, so I see patients with esophageal, gastric, pancreas, stomach, colon, liver, and other GI cancers. I sub-specialize in hepatic malignancies such as metastases to the liver and primary liver cancers. We have a busy multidisciplinary outpatient clinic at Duke, and my team and I see a wide range of patients there three days a week. On a typical day, the first patient we see might be coming in for a followup exam five years out from their cancer; the next might be starting a new round of chemotherapy for an advanced cancer. The third might be coming in to enroll in a clinical trial, while the fourth might already be on a clinical trial. Each week we have a multidisciplinary GI conference where the team—including radiologists, surgeons, oncologists, nurses, and physician assistants—discusses cases and plots strategies.

When I’m not in the clinic, I spend as much time as possible on my research, which is focused on developing and testing new cancer vaccines and other drugs that can help our patients. I started this research during my fellowship, working with Dr. Kim Lyerly, who is now director of the Cancer Center. We have an interdisciplinary group that works closely together, including physician scientists,PhD scientists, post-doc students, and laboratory technicians. My main role is translating the basic science development of vaccines into clinical trials and designing and overseeing these trials.

Right now we’re performing cutting-edge studies on using vaccines therapeutically: we’re trying to take someone who has cancer and stimulate their immune system to do a better job of attacking the cancer. We start in the basic science laboratories developing potential cancer vaccines, then we go through testing in animal models, write clinical trial protocols, get regulatory approval and grant funding, and then conduct a clinical study and analyze the results.

Several of the vaccines we’ve created use dendritic cells, the primary immune stimulators in the body. These vaccines cause the immune system to attack tumors by causing them to recognize antigens, proteins that appear foreign to the immune system. We’ve also tested vaccines that use viruses to tell the dendritic cells what they should tell the immune system to do. So far, we’ve been seeing signs that we are activating the immune system to recognize cancers, and our goal is to get better and better at stimulating the immune system. One example is a vaccine being tested for people who had surgery to remove colon cancer that had spread to the liver. As many as three quarters of these people—even with chemo—have the cancer come back eventually. Through these studies, we’re trying to determine if a vaccine can reduce the chance of the cancer coming back and, if so, what’s the best kind of vaccine.

Another important part of my job is teaching. Medical oncology fellows and medical students rotate through the GI clinic, and I also teach residents while doing rounds on the inpatient services at Duke Hospital and the Durham VA Medical Center. Our GI clinic presents a great opportunity to learn because medical oncology requires you to address a lot of the same chronic medical issues as internal medicine, but it also presents acute illnesses that must be managed. Hopefully it gives young physicians who might be interested in medical oncology a taste of what it’s like.

What I like about my job is that every day is different. I like variety, which may be why I’m in academics. I like variety in my personal life, too. My wife, Emy Louie, is an architect, and more artistic than scientific. We come from different ethnic backgrounds, and we have very different personalities, but it works well—it’s exciting. Our daughter, Amber, mixes many of our qualities. She likes to dance and be theatrical, and she’s incredibly gregarious. I find it fascinating to watch her grow up.

As an oncologist, it’s challenging to take care of people who have serious illnesses. There are many rewarding aspects of this work: interacting with people; developing something successfully in lab or having a clinical trial that shows promising results; being asked to deliver a speech at a national meeting; or having people from other parts of the world come to us for treatment.

In this profession, you have trying times and you have triumphant times. Fortunately, the triumphant times get you through the trying times. The courageous people I meet and work with every day are constant reminders of what’s really important.