March is Myeloma Awareness Month, and it’s also Women’s History Month. So what better time to spotlight LLS-funded women scientists who are driving discovery for myeloma patients.
In this first of my two-part series on myeloma researchers, I sat down with Urvi A. Shah, MD, MS, an Assistant Attending in the Myeloma Service at Memorial Sloan Kettering Cancer Center.
Dr. Shah is currently investigating whether a high-fiber plant-based diet, along with virtual coaching, can improve outcomes and quality of life for newly diagnosed myeloma patients. She is studying whether such a diet can lower body mass index (BMI) and insulin resistance—two factors that have been linked to shorter remissions and poorer outcomes—and whether it can prompt a better response to myeloma treatment. If successful, her three-year study will directly benefit myeloma patients by identifying a new low-risk, low-cost intervention that improves their chances of feeling better during and after treatment.
I wanted to know how Dr. Shah got involved in science in the first place and how she came to specialize in myeloma research. I also asked about her role models and experiences as a woman in the field, and to share her best advice for myeloma patients.
Here are highlights from our conversation.
How did you decide on a career in science?
I grew up in India in a family where my grandfather, great grandfather, father and
uncle were all doctors. I always liked science—physics and math more than biology. Within science, I didn’t really know of too many career options—it seemed like you either become a doctor or an engineer. But I felt that by being a doctor, I could interact with patients and impact people directly. That's why I decided to go into medicine.
Why blood cancer?
In medical school I first thought I wanted to be generalist, caring for people with different diseases. So, I took internal medicine. But then I started thinking about specialization, gravitating toward oncology and hematology because cancer and blood diseases, and their various treatments, affect the whole body.
During my fellowship, I started to do research so that I could figure out what I wanted to do long term as my career. But toward the end of my first year of fellowship I was diagnosed with Hodgkin lymphoma.
Here I was, a patient myself, caring for others who had blood cancer—many with the same disease as me. I did the standard chemotherapy for four months and found it hard to just sit back and focus on my treatment. I kept myself busy by actively pursuing research projects focused on adult T cell leukemia and lymphoma. By the end of my fellowship, I realized that I really liked this work and wanted to stay in academia.
How did you wind up specializing in myeloma?
I landed an advanced fellowship in immunotherapy, studying CAR-T cell therapy at Memorial Sloan Kettering (MSK), the same place I was treated for my cancer. It felt like I was coming full circle. I was interested in researching either lymphoma or myeloma but found there were more opportunities in myeloma at that time. As I did my myeloma research, it turned out that MSK was also looking to hire someone on staff to specialize in myeloma. I got hired to the faculty before I finished the fellowship!
Why is your research important for myeloma patients?
Since my own diagnosis, I had become interested in whether it’s possible to modify the risk factors for cancer through diet. The research I do focuses on understanding how modifiable factors like nutrition, diet, and physical activity affect treatment response and cancer outcomes.
Myeloma provides a great opportunity to study this because it is one of thirteen cancers linked to obesity. We know a lot about the very earliest stages of myeloma, before symptoms are even present. There are two conditions called Monoclonal Gammopathy of Undetermined Significance (MGUS) and smoldering myeloma that are a precursor to myeloma in some patients. For MGUS and multiple myeloma, the disease can be easily measured over time by a marker in the blood to help determine whether dietary interventions, along with treatment, can make a difference in outcome.
In this era of immune therapies, myeloma patients are living longer, so we’re able to explore what else can help improve their quality of life.
Were there women role models who inspired and motivated you?
Even though it was the males in my family who were the doctors, my mother has been a strong role model for me. She's not a physician, she’s a psychotherapist. But she has always been an independent thinker, which was not encouraged at the time she was growing up in India. Her father believed that she should get a good education, but also didn’t think women should work after getting married. My mother wanted to get a master's degree in social work, and have the experience of studying and learning in the U.S. But she knew her dad wouldn’t agree. Without his knowledge, she applied to Washington University in St. Louis and negotiated with admissions to take her credits from India and let her do the program in one year instead of two. When she told her dad she’d been accepted, she promised to come back in a year and get married. And so, he let her go.
After she returned to India with her master’s degree, she got married, started her family, and eventually started working. Throughout my childhood I watched her accomplish many things and take on different roles, both as a psychotherapist, and also by hosting classes for children and holding wellness and relationship workshops. She showed that you need to think creatively and outside the box—especially when you’re in a society that doesn’t expect you to have a career, and where most of your peers are not working. She has managed to step outside of all that and be successful. She’s been a great inspiration to me.
What’s it like to be a woman in research?
When we start out in our careers, there’s an equal number of women and men. But as we move up, the leadership positions are very heavily skewed toward males. I think it’s because we still don’t have a lot of role models in the field and see as many women doing it. We need more women staying in it for a long game, even though they may face more hurdles along the way.
Personally, I’ve had very supportive mentors throughout my career. But there are sometimes unspoken biases that people may not even realize they have.
A good example of this was proven by a pair of Columbia Business School professors. They took a Harvard Business School case study about a successful venture capitalist Heidi Roizen and changed her name to Howard in half the classes. While both groups rated Howard and Heidi equally in competence, Howard rated higher in likeability and Heidi was perceived to be less humble and more power hungry. The study confirmed that gender stereotypes and subconscious biases can affect how women are perceived in their careers. People still tend to think of men more as leaders and women as nurturers. As women, we must actively move beyond this bias. And it’s important that we support other women as they’re coming up in their careers.
When you don’t see enough role models in your field, it can be a bit lonely. But I think it’s changing. At MSK, our Department of Medicine Chair is a woman and so is our Physician in Chief. As physician scientists reach more leadership roles, we are bringing more equality for all women going forward.
What are you most excited about in the myeloma field?
The potential that we may be curing this disease is quite exciting. When I was in medical school, patients lived only a few years and there were just a few therapies. But today it is remarkable to see the progress made.
Myeloma patients are living longer, and now in many cases it can now be managed as a chronic condition. I think that the research I'm doing fits in well with where the field is going. We need to think beyond just therapy, and about how to live better.
What’s your best advice for myeloma patients?
It's a marathon and not a sprint. Take the disease one step at a time and focus on the present and what is in your control. I know as a blood cancer patient myself that we can get caught up in worrying about the future or the next therapy. When you have periods where you’re off treatment or in remission, focus on doing the things that really matter to you.
ABOUT URVI A. SHAH, M.D. M.S.
Dr. Urvi Shah is an Assistant Attending in the Myeloma Service at Memorial Sloan Kettering Cancer Center. She is board certified in Internal Medicine, Hematology and Medical Oncology and received a Master of Science degree in Clinical and Translational Cancer Research. Her research interests include modifiable risk factors (diet, metabolism, microbiome) in cancer. She completed the first pilot nutrition trial in plasma cell disorders to date (NUTRIVENTION) and has 3 other dietary trials enrolling. Dr. Shah has been supported by career development awards (National Cancer Institute [NCI] K12, International Myeloma Society and American Society of Hematology [ASH] Scholar) and research awards (ASH CRTI, ECOG ACRIN Young Investigator Translational Research, Henry Moses, Celgene Future Leaders in Hematology, NCI Early Investigator Advancement Program, Clinical Cancer Research Early Career and ASH CRTI Goldenberg). She has published papers in prominent journals and has been an invited speaker and chair.
Read more about Dr. Shah’s research here.
ABOUT THE AUTHOR
As LLS's Chief Medical Officer (CMO), Gwen Nichols, M.D., plays a critical role in advancing cures through a unique combination of clinical, academic and pharmaceutical experience. She oversees LLS's scientific research portfolio, patient services and policy and advocacy initiatives. Dr. Nichols leads an international team of preeminent leaders in pediatric acute leukemia to conceive, develop and implement LLS PedAL, a first of its kind global master clinical trial and a key component of the Dare to Dream Project, transforming treatment and care for kids with blood cancer.
A physician and scientific researcher, Dr. Nichols has dedicated her career to advancing cures for cancers. Before joining LLS, she was oncology site head of the Roche Translational Clinical Research Center, where she worked to develop new cancer therapies, translating them from the laboratory to clinical trials. Prior to joining Roche in 2007, Dr. Nichols was at Columbia University for more than ten years, where she served as the director of the Hematologic Malignancies Program.
While at Columbia University, Dr. Nichols maintained an active clinical practice and received the prestigious honors of "Physician of the Year" from Columbia University and the "Humanism in Medicine Award" from the American Association of Medical Colleges.