Horne LL, et al. Abstract LB173. Presented at: American Association for Cancer Research Annual Meeting (hybrid meeting); April 8-13, 2022.

Horne LL, et al. Abstract LB173. Presented at: American Association for Cancer Research Annual Meeting (hybrid meeting); April 8-13, 2022.

A community-based oncology consortium effectively gathered nearly 2,000 unique genomic data sets from Black patients with cancer residing in Black Belt states, according to study results.

The data sets could contribute to better understanding of cancer health disparities in this patient population and democratize precision medicine, researchers noted.

“Precision medicine is not available to everyone. We are working to democratize the precision medicine space, with a specific focus on the oncology space because we need more data in this area to narrow known existing cancer health disparities,” James W. Lillard Jr., PhD, MBA, senior associate dean of research, innovation and commercialization at Morehouse School of Medicine, said during an interview with Healio.

Researchers at Morehouse School of Medicine and Tuskegee University formed the Comprehensive Approach to Reimagine Health Equity Solutions consortium, which aims to bring precision cancer medicine and personalized care to underserved and underrepresented communities.

Lillard spoke with Healio about the consortium, what he and colleagues have found so far, and his ultimate hope for this work.

Healio: What prompted this research?

Lillard: There are many health disparities in the country, and new light was shed on them during the COVID-19 pandemic. Among Black individuals, we saw as high as 40% increased mortality rates due to COVID-19, and incidence was even higher in this group. Some of those same trends occur in the cancer space. For example, a higher percentage of Black women are diagnosed with triple-negative breast cancer, more Black men and women are diagnosed with colorectal cancer, and more Black men are diagnosed with and die of prostate cancer. Many factors contribute to these health disparities and are considered social determinants of health — the biggest of which is access to care.

In addition, we need more data in the Black communities. In the past, data have been collected in areas with Black individuals representing only 3% to 5% of the population vs. places like Atlanta, where 30% to 40% of the population is Black. We are defining this lack of data sets in this patient population as a new determinant of health.

Healio: Can you talk about your specific focus on the Black Belt and how this research can be applied outside the Black Belt?

Lillard: We chose to focus on the Black Belt because these areas constitute 30% to 40% of the Black population, but this research can be applied anywhere. There is another interesting disparity —80% of patients with cancer in this country receive treatment in a community-based oncology setting. These centers do not have access to all the tests available. Many previous studies have been conducted at comprehensive cancer centers that have tons of resources and staff to conduct next-generation sequencing and make sense of the data. We are working to provide this in the community oncology setting, as well.

Healio: What have you found so far?

Lillard: We have been able to glean a lot of information from the clinical and claims data. We find that we can do a better job assessing health literacy and transportation issues our patients face in getting to their appointments. We have been able to develop social intervention strategies to mitigate some of the social determinants of health.

I study how the immune system interacts with cancers and utilize a significant amount of data science to make sense of it all. Each data set we collect consists of terabytes of data per patient, so stitching together the entire story of a patient is essential.

Morehouse School of Medicine’s mission is to create and advance health equity. In order to achieve health equity, we cannot remove the element of race, income or geography from the equation. We need to consider the entire story — the entire background of the patient to give them equal health care. We also found that there is often very different biology between people of African vs. European ancestry for any given cancer.

This is an exciting time for precision medicine because the cost of next-generation sequence testing is decreasing and the compute time is coming way down. This is the era of convergence, where we’re blending biomedical science with data science. For example, a graduate student at Morehouse School of Medicine, Lawrence McKinney, is doing his PhD in my laboratory using weighted gene expression network analysis, where we utilize a machine learning data science technique to correlate clinical phenotypes, such as cancer mortality or cancer metastasis or response to therapy, with molecular signatures. Interestingly, this is what Facebook uses to determine which groups of people are communicating with each other on the social network. Exploiting that technology, we’ve identified target genes that are highly expressed during metastatic prostate cancer in certain patients and other genes that are significantly downregulated. With this information, we can design drugs to target those upregulated factors that are driving the survival of a tumor in the bones, if it is metastasized, or we can use genetic engineering to deliver genes that have been deleted. All of this was made possible by collecting these data sets.

Healio: What are some of the challenges that you have encountered in conducting this research and how have you overcome them?

Lillard: For one, we had to navigate around a flood for a few months at one of the hospitals in the area that we were working with. Then the COVID-19 pandemic hit and we had to shut down nonemergency services, which prevented our staff from being able to engage with patients for our research for nearly 1.5 years. These were significant obstacles, but my colleague Latrisha L. Horne, who is coordinating all the moving pieces of this research, was able to develop telemedicine approaches that reached out to patients directly at their home and tools to enroll them in our study.

Other obstacles we encountered included the fact that some oncologists provide care the way they want and may not necessarily find it critical or useful to have a complete blueprint of a cancer they are fighting. However, we know that next-generation sequencing offers more data and helps with clinical decision support. We also faced challenges with funding. We are not a comprehensive cancer center, so we don’t have a huge endowment. We are fortunate to have received funding from American Association for Cancer Research and other foundations for our research, but we are now looking to sustain the funding to keep our research going.

Healio: What is your ultimate hope for this work?

Lillard: This work has sparked the creation of different education programs within medicine. Precision medicine is more than just genetics — it is health informatics, bioethics, genetic counseling and many other things. We are now beginning to create graduate programs and established a biotechnology program a couple of years ago at Morehouse School of Medicine. We also established a master’s program in health informatics 1 year ago. We want to create more applied science STEM programs in this regard.

We also hope the clinical, social and molecular data sets we are acquiring, structuring and presenting will to lead to new cancer therapies and new biomarkers so that we can, hopefully, detect more cancers early on or even biomarkers for risk assessment and risk stratification of patients who do not have cancer but maybe have a family history of cancer.

Lillard: We are continuing to collect specimens and are conducting transcriptome analysis and whole exome sequencing of genes. We are looking to expand that and conduct whole genome sequencing of germline variants in the tumor samples we have. By doing this, we hope to identify new genetic risk factors for cancer that may have been overlooked among Black individuals.

In previous years, specimens were collected in Boston, New York and New England, for example, but not in places like Atlanta. As a result, there is a bit of a global ancestry bias toward the genetics of European ancestry as opposed to African ancestry. Hundreds of variants may be significant if we had the clinical data to see if they really do matter. Is it a risk factor for breast cancer, or ovarian or endometrial cancer? This type of research is ongoing.

Healio: Is there anything else that you would like to mention?

Lillard: A lot of people are behind this study, including community health workers, lab techs, pathologists and oncologists. In addition, AACR; Margaret Foti, PhD, MDMichael Keller, MD; and Gerald E. Hanks, MD, drove funding for this study way before the Black Lives Matter movement and before COVID-19. There are now a lot of diversity and inclusion initiatives across the country, and we have a lot of people coming to Morehouse School of Medicine to partner and collaborate with us, but they were so far ahead of the game.

James W. Lillard Jr., PhD, MBA, can be reached at Morehouse School of Medicine, Hugh Gloster Building, 830 Westview Drive SW, Atlanta, GA 30310; email: jillard@msm.edu.

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