May 12, 2018:

Investigator Spotlight

Monika Joshi, MD, MRCP, Penn State Cancer Institute 

Educational Background

• MB, BS, Kasturba Medical College, Manipal Academy of Higher Education
• Member of Royal College of Physicians, London
• MD Residency, Internal Medicine, Pinnacle Health Hospitals
• Hematology/Oncology Fellowship, Penn State Cancer Institute, Penn State Health Milton S. Hershey Medical Center

Research Interests

My clinical and research interests lie primarily in the field of genitourinary (GU) tumors, developing novel therapeutic combinations and biomarkers for GU cancer of the bladder, kidney and prostate. I have a keen interest in developing novel combination therapies with immunotherapy. For example, bladder cancer is considered aggressive, and checkpoint blockade immunotherapy has shown efficacy in this disease. Unfortunately, the therapy only works in approximately 25 percent of patients. Research suggests that priming the immune system with radiation could convert some non-responders to responders. We are currently investigating the role of adding radiation to a checkpoint inhibitor (durvalumab) in bladder cancer that is locally advanced. If successful, this novel approach could ultimately lay the foundation for bladder preservation strategy with immunotherapy in this unique subset of bladder cancer patients who have extensive local disease without any signs of distant metastases. I also serve as a co-leader for the GU diseases group at the Penn State Cancer Institute and was recently appointed as a co-chair of the Big Ten Cancer Research Consortium’s GU Clinical Research Working Group. Serving in this capacity helps me facilitate the groundbreaking research conducted by my colleagues in the consortium.

Little-known facts about Dr. Joshi:

• I am an artist at heart. I love sketching.
• I love playing video games.
• I enjoy practicing yoga to stay healthy.

Thought Leader Perspectives

Monika Joshi, MD, MRCP

Working Toward a Cure: Immunotherapy for Cancer Patients
Few medical terms generate as much excitement as the use of “cancer” and “cure” in the same sentence. Yet, in just a few short decades, I believe we will be routinely combining those two words, thanks to a third word: “immunotherapy.”

Immunotherapy is an important option for treating cancer. It uses the body’s own immune system to kill cancer cells. Although discovered in 1890 by William Coley, oncologists have only relatively recently recognized the value of this treatment modality in cancer therapy. Immunotherapy drugs work by helping the immune system find and kill cancer cells, which often hide behind fake signals. These signals (technically called checkpoints) trick the immune system into leaving them alone by making the immune system think they’re normal, healthy cells. Some immunotherapy drugs help take off the blinders, revealing cancer cells to the immune system and allowing the body’s natural defenses to take over and kill the cancer. Others stimulate the body’s immune system to make special cells (called T cells), which kill the cancer cells.

Regardless of the approach, early research and clinical experience with these therapies indicate that not only can they be very effective in some patients—putting them into long-term remission—but they also may do so with fewer side effects, meaning patients can have a higher quality of life during treatment. Anyone who has experienced nausea, vomiting or hair loss from chemotherapy can attest to the appeal of an effective drug with limited side effects.

And the best part?

Many immunotherapies have already been approved by the Food and Drug Administration to treat several types of cancer, and many more are under development and undergoing clinical trials.

While these “therapies of the future” offer a lot of promise, enthusiasm regarding their use should be tempered with caution. It is important to remember that:

1. Not everyone responds to immunotherapy. Like many other therapies for cancer, immunotherapy isn’t a one-size-fits-all miracle. We still have to figure out who responds and why, as well as what we can do to help more people respond.

2. Immunotherapy is extremely expensive. Right now, even if immunotherapy is approved and available in certain types of cancer, some patients may end up choosing chemotherapy or other options first, as their insurance copay for immunotherapy could be extremely high. While these treatments are often entirely appropriate and likely to benefit patients, we need to start creating pathways toward more affordable immunotherapy so that patients who may benefit from it or prefer it can obtain it.

3. We need more patients in clinical trials. Immunotherapy can sometimes be effective even in cases of very advanced cancer. People with cancer diagnoses, regardless of the stage, should ask their oncologist whether any clinical trials are available for them in the field of immunotherapy, if they’re interested—research is how we get to a cure.

4. Chemotherapy isn’t going anywhere. We can’t wish it away yet. In fact, a number of ongoing research studies are looking at the effects of combining immunotherapy and chemotherapy or radiation therapy to see if we can boost response rates. Current treatment methods may help us maximize the power of immunotherapy.

5. Personalized medicine needs more work. In immunotherapy and other cancer research, we need biomarkers and genotyping to help us truly understand what is going on in cancer cells and how we can predict whose cancer will respond to which type of therapy. Once we know exactly what subtypes of cancer people have and which treatments work against those subtypes, we’ll be creating treatment plans that truly target each individual patient’s needs.

Immunotherapy research is a fascinating and exciting field, with constant progress. My own research efforts and those of many others in the Big Ten Cancer Research Consortium have been filling in the blanks, edging toward a cure for more and more patients. It is very rewarding to see patients with previously untreatable forms of cancer get better and stay well.

Immunotherapy is not a magic bullet for cancer treatment, but I believe it is the most promising tool we have at our disposal. It is my hope—one that I know is shared by many—that within just another decade or two, we will include the word “cure” in our vocabulary far more often.

About the Big Ten Cancer Research Consortium: The Big Ten Cancer Research Consortium was created in 2013 to transform the conduct of cancer research through collaborative, hypothesis-driven, highly translational oncology trials that leverage the scientific and clinical expertise of Big Ten universities. The goal of the Big Ten Cancer Research Consortium is to create a unique team-research culture to drive science rapidly from ideas to new approaches to cancer treatment. Within this innovative environment, today’s research leaders collaborate with and mentor the research leaders of tomorrow with the unified goal of improving the lives of all patients with cancer.

About the Big Ten Conference: The Big Ten Conference is an association of world-class universities whose member institutions share a common mission of research, graduate, professional and undergraduate teaching and public service. Founded in 1896, the Big Ten has sustained a comprehensive set of shared practices and policies that enforce the priority of academics in the lives of students competing in intercollegiate athletics and emphasize the values of integrity, fairness and competitiveness. The broad-based programs of the 14 Big Ten institutions will provide over $200 million in direct financial support to almost 9,500 students for more than 11,000 participation opportunities on 350 teams in 42 different sports. The Big Ten sponsors 28 official conference sports, 14 for men and 14 for women, including the addition of men’s ice hockey and men’s and women’s lacrosse since 2013. For more information, visit www.bigten.org.