OHSU Oncologist Pioneering Prostate Cancer Research While Expanding Access to Cutting-Edge Care

"We are not focused on giving immunotherapy to everyone. We are focused on picking the right patient to receive immunotherapy," said Dr. Julie Graff, reflecting on her approach to prostate cancer research and treatment.

Dr. Graff's work addresses a critical challenge in cancer care: prostate cancer has remained largely resistant to immunotherapy treatments that have revolutionized care for many other cancer types. "Checkpoint inhibitors have been very successful in many cancer types, but never prostate cancer," she explained. Rather than accepting this limitation, Dr. Graff is pioneering novel approaches that could fundamentally change how the disease is treated.

Her research focuses on the gut microbiome's role in treatment response, investigating how the bacteria in patients' digestive systems might influence their response to immunotherapy. "We are starting a study where we give patients a can of beans to hopefully breed or encourage the good bacteria in the gut to expand," Dr. Graff said, describing one of her current clinical trials. "In another study, we are giving fecal microbiota transplants, taking a stool from responders to immunotherapy and giving it to non-responders, and then retreating."

Dr. Graff's commitment to advancing care extends beyond the laboratory. As the founding director of the Veterans Affairs Prostate Cancer Analysis for Therapy Choice (PATCH) program since 2019, she leads a consortium of VA hospitals conducting clinical trials specifically designed to serve the veteran population. "We have a lot of VAs who have a far more diverse population than we do here in Portland," she noted, highlighting a critical advantage of her work.

While traditional prostate cancer studies often include only 10% African-American participants, Dr. Graff's consortium achieves 36% participation from African-American patients, creating a study population that truly mirrors the country's demographics. "We have been able to achieve a group, enroll patients who mirror the demographics in the country," she said, addressing a longstanding challenge in clinical trial diversity.

Understanding that innovative treatments mean little if they do not reach the clinicians who need them, Dr. Graff has embraced educational leadership through her partnership with Binaytara, an oncology nonprofit based in Bellevue, Washington. For the third consecutive year, she served as co-chair for the Best of ASCO Portland Conference, bringing cutting-edge cancer research directly to community practitioners who might not otherwise have access to such resources. Dr. Graff's leadership at the conference, which saw record attendance from healthcare practitioners, faculty members, and industry stakeholders, highlights its significant impact across multiple healthcare sectors.

"Even if you go to the American Society of Clinical Oncology (ASCO) meeting, sometimes it is hard to put things in context," Dr. Graff explained. "It's nice to hear experts talk about how these studies actually fit into practice." The conference serves physicians who may not have the time or resources to attend the massive ASCO annual meeting in Chicago, ensuring that geographic location does not determine access to the latest advances in cancer care.

The conference Dr. Graff chaired also reflects her commitment to developing the next generation of oncologists. "One of the beautiful things about this conference is that we are encouraged to invite trainees to do the case studies," she said, providing residents and fellows with opportunities to hone their skills before entering independent practice. Binaytara’s educational goal to include more nurse practitioners and other healthcare professionals resonates with Dr. Graff, as she notes that "nurse practitioners are absolutely critical to our success in the clinic and they deserve to have the same level of education that physicians have."

Dr. Graff's work at OHSU exemplifies the institution's robust research environment, where she collaborates across disciplines to tackle complex challenges. Her clinical trials at the VA hospital have been made possible through funding that allowed her to hire study coordinators and research team members, recognizing that "if you don't have those support people, you can't really do research effectively."

Through her innovative research, commitment to diversity in clinical trials, and dedication to education, Dr. Graff continues to expand access to cutting-edge cancer care while pioneering treatments that could transform outcomes for prostate cancer patients worldwide. Her work ensures that whether a patient receives care at a major academic medical center or a community practice, they have access to the most current, evidence-based treatments available.