By Merin C. MacDonald
Kriti Mittal knew from a young age that she wanted to be a doctor. Although she had no physicians in her immediate family, she was fascinated by how the human body and medicine worked. Growing up in New Delhi, she spent her formative years imagining a life in medicine. “From pretend play with cousins to signing up for a young doctors’ club in after school, it is clear to me that medicine has always been my calling,” said Dr. Mittal.
Kriti Mittal, MD, MS, is an assistant professor of medicine and physician in the Division of Hematology/Oncology who specializes in genitourinary cancers including bladder, prostate, kidney, and testicular cancer. Dr. Mittal also serves as director of genitourinary oncology and chair for the Epic Beacon Partnership Council. In this month’s Chair’s Spotlight, Dr. Mittal discusses her path to becoming an oncologist, what inspires her, and her enthusiasm for a new initiative for physician and patient advocacy in immune-related adverse events.
Dr. Mittal attended medical school in Mumbai, India, and in her third year, was drawn to conducting scientific research in addition to treating patients. Following medical school, she moved to the United States to pursue a graduate degree in microbiology at Clemson University in South Carolina. She then went on to complete her internal medicine residency at St. Vincent Hospital in Worcester, Massachusetts, where, at the time, there were a lot of clinical and education connections with UMass. “Many residents who wanted to apply to fellowships and get exposure to subspecialties would rotate at UMass,” said Dr. Mittal. “During my three months of rotation at UMass, the faculty were incredibly welcoming.” It was then that she first connected with William Walsh, MD, who at the time was the director of the hematology/oncology fellowship program, as well as Venu Bathini, MD, who was the associate program director. “Both Dr. Walsh and Dr. Bathini were incredibly inspiring and instrumental in my formative years.”
Dr. Mittal completed three years of fellowship in hematology/oncology at the Cleveland Clinic Foundation in Cleveland, Ohio where she trained with international leaders in the field of genitourinary oncology. Having made Central Massachusetts her home base since residency, she happily returned to the area in 2014, and after hearing from Dr. Walsh that a genitourinary oncologist position had opened up, she applied and began her career at UMass in 2017. “It is amazing how my colleagues who have worked at UMass always keep in touch and everyone is so supportive.”
Over the past seven years, Dr. Mittal has seen a lot of growth within her division and specialty. “I think the Medical Group has done an excellent job at physician retention and growing our program,” she said. “At the same time, drug development throughout the world has accelerated and I think patients are benefiting from all of the scientific research that's going on in oncology globally, especially in genitourinary oncology.”
Dr. Mittal was recently invited to be a member of the Immune-Related Adverse Events (irAE) Consortium, a group of representatives from 28 organizations including academic, non-profit, and industry who have come together to address immune-related adverse events to improve patient care and promote research development.
Many of the treatment options in genitourinary oncology are immunotherapy based which has dramatically changed how patients are treated, especially those with bladder and kidney cancers. Immunotherapy allows people to live longer and treatments are much better tolerated than chemotherapy, but it is not without side effects. Side effects of immunotherapy are very difficult to track because they can present with nonspecific symptoms. Thus, there is a need to educate all clinical providers, not just oncologists, about how patients who are receiving immunotherapy may present with symptoms.
“Immunotherapies have been around since 2012, and the first approval for immunotherapy for genitourinary cancers came in 2014,” said Dr. Mittal. “It's been 10 years and we still do not have timely recognition of immunotherapy-related adverse events.”
Dr. Mittal is first author of a report published in May in The ASCO Post that describes the work of the irAE Consortium. “The consortium has two arms—ASPIRE, for clinicians who provide care to patients and are interested in researching these side effects; and STORIES, for patient advocates and caregivers to bring their perspective to the consortium,” said Dr. Mittal.
A critically important part of the irAE Consortium’s work thus far has been their successful application to the Center for Medicaid Services (CMS) to have new billing codes relating to immunotherapy-specific side effects added. Dr. Mittal explained the importance of these new billing codes which will go into effect on October 1, commenting, “It will allow us to bill properly for side effects of immunotherapy, and in the medical record, the diagnosis will be more accurate.” She continued, “Once we have accurate billing codes, it will allow us to capture the incidence and prevalence, and conduct research into how often people get these side effects. If you can't assign a billing code, there is no way you can track, over time, how many people in the real world are getting these side effects. This is a huge step.”
We thank Dr. Mittal for her commitment to the advancement of clinical care and research, her advocacy, and for her dedicated care of her patients.
Read about the work of the irAE Consortium in The ASCO Post.