Cancer is a leading cause of sickness and death around the world, with limited treatment options available for people whose disease has progressed or spread. While new treatments have improved how long people can live with cancer, lifespan for those whose disease has spread has seen far less improvement. One reason for this is the cancer’s ability to become resistant, or “immune,” to treatment. A new method of treating cancer, called precision oncology, uses molecular testing to not only understand how and why a tumor grows, but also how it can begin to become resistant to treatments that may have once worked.
One challenge, however, is that access to this molecular testing is not always available to all groups of people. This unequal access, based on race and other factors, can have a measurable impact on cancer patients’ lives — in a recent study, black patients were 38% less likely to receive this type of testing compared to white patients. Through our research, we hope to change this to create a more equal approach to cancer treatment regardless of race or other factors. To do this, we will create a high quality molecular testing program in the DC region, with particular attention to communities in need of more equal access to these treatment approaches. By including all racial groups more equally in this research, we will also be able to better answer future research questions in a way that does not exclude any groups of people.
Washington, D.C., has some of the highest cancer death rates in the United States, especially among the the Black and Latinx communities in Wards 7 and 8. This is caused by differences in living conditions that make it hard for Ward 7 and 8 residents to get trusted information on ways to avoid cancer, as well as cancer screening that can find the disease early when it is more treatable. This means many women in Wards 7 and 8 find out they have breast cancer when it is farther along, harder to treat, and may not be curable. This work, through the Johns Hopkins Kimmel Cancer Center in the National Capital Region and Sibley Memorial Hospital, can help to address these differences.
To help fix these disparities, the first step is to share information with communities on ways to lower the chances of getting cancer and the tests that can find it early. We will begin with a focus on preventing and detecting breast cancer. Working with the community, we hope to help more women stay healthy and never need to be treated for breast cancer. Our educators will give coaching on ways to live a healthy life – like through diet, exercise, and how to quit smoking – as well as how and when cancer screening should be done so it can be found early. It is our hope that these efforts will mean that fewer women will be diagnosed with breast cancer, and those who are will have a better chance of surviving the disease.
FUNDED BY THE STUART SCOTT MEMORIAL CANCER RESEARCH FUND WITH SUPPORT FROM BRISTOL MYERS SQUIBB
Heart disease and low blood counts are common complications for men with prostate cancer. There are some reasons why this might happen that are already known – either because of the cancer itself or because of some of the treatments for cancer. Recently, scientists have found that white blood cell clones (cells that all come from one cell; called CHIP) have changes in their DNA that might put people at higher risk for heart disease, complications with blood counts, and death. CHIP, like prostate cancer, is associated with age, and may be contributing to heart disease and blood count problems we see in men with prostate cancer. This study will look to see if men who have CHIP with prostate cancer have worse outcomes and if new treatments for prostate cancer contribute to CHIP.
RAS is a gene that plays a major role in cancer. The three members of the RAS family are HRAS, NRAS, and KRAS. One of these genes is mutated in about 15% of cancers. The mutant form is hyperactive.
In pediatric solid tumors, RAS is mutated in about 1-3% of cancers and more often in rhabdomyosarcoma.
Inhibiting RAS activity has been a difficult task in cancer drug development. One type of drug, the farnesyl transferase inhibitors (FTI), were developed twenty years ago. Clinical trials using these drugs were disappointing. We now have a better understanding of how to select patients that will best respond to FTI.
Only mutant HRAS is dependent on the farnesyl transferase enzyme. So, FTI should work best in patients with HRAS mutant cancers.
In a clinical trial of patients with HRAS mutant head and neck cancer, patients were treated with tipifarnib, an FTI. Trial outcomes showed that patients’ tumors got smaller (responded).
We are now studying FTI in pediatric solid tumors. We want to know what adaptive events occur in the cell and whether these changes only occur in mutant HRAS tumors. We also want to learn how tumors may escape the anti-cancer effects of FTI.
Studying these changes and paths of resistance can help us develop more complete and lasting responses. Our study aims to address these issues to find effective treatments for patients with HRAS mutant cancer.
Funded by the Constellation Gold Network Distributors
Only a limited number of proteins are found in nature, and many of them have multiple different functions that clash with one another, which makes them poor drugs. There is a growing interest in engineering existing proteins or designing brand new proteins that are better than the ones in nature. Most current methods for protein design use a random approach. However, as our understanding of protein structure improves, we have an exciting chance to use structure to guide design. My lab applies new tools from biology and engineering to figure out the mechanisms that control protein behavior. We then use this information to discover and develop better drugs.
One of the biggest cancer breakthroughs is immunotherapy, which activates the patient’s own immune system to fight disease. My lab aims to bias the activity of immune proteins in order to achieve a targeted response against cancer. For more than twenty years, immune proteins such as cytokines and antibodies have served as powerful weapons in cancer treatment, but they are limited by issues such as drug resistance and harmful side effects. As a result, there is an unmet need to create new proteins that overcome these challenges. Building on our lab’s insights and platforms we have designed, we will make a new protein drugs that act through unique pathways to induce potent anti-cancer immune responses.
Our body’s immune system recognizes and destroys foreign invaders such as infections or cancer. Malignant tumors try to outsmart and hide from the immune system. Therapies that activate T cells, a key part of the immune system, are effective against multiple cancers. Myeloid cells are a second important part of the immune system. Myeloid cells can be activated by removing a protein called p50. Our laboratory finds that infusion of myeloid cells lacking p50 into mice leads to shrinkage of several types of cancer, including prostate and pancreatic cancers. We now seek to further improve the effectiveness of myeloid cells lacking p50, to develop human myeloid cells lacking p50 suitable for use in patients, and to evaluate the ability human myeloid cells lacking p50 to shrink human prostate and pancreatic cancers growing in mice. We anticipate that completion of these studies will allow us to begin clinical trials testing the benefit of human myeloid cells lacking p50 as a novel treatment for multiple cancers.
Funded by the Stuart Scott Memorial Cancer Research Fund
Antibody treatments that block ‘immune checkpoints’ which prevent the immune system from fighting cancer, have resulted in impressive tumor shrinkage and long term survival in many patients with cancer. Results from studies in metastatic triple-negative breast cancer (TNBC) indicate promising activity but not yet the exceptional results seen in tumors known to be highly “immunogenic” or responsive to alterations in the immune system. Strategies to make TNBC “immunogenic” are therefore of great interest as they may result in long term control of TNBC. This is of particular relevance to minority groups such as the African American population, who often present with an aggressive TNBC with limited treatment options available.
Our collaborators at Johns Hopkins have laboratory data, suggesting that combining the histone deacetylase (HDAC) inhibitor entinostat with immune-checkpoint blockade (nivolumab and ipilimumab) led to eradication of breast tumors and long term cures. Research suggests that entinostat may alter the tumor environment by affecting the regulatory immune cells which can prevent immune-checkpoint agents from fighting cancer. This combination may thus be able to convert these traditionally “non-immunogenic” tumors into tumors which can respond to immune therapy.
We are thus conducting a phase I clinical trial of entinostat, nivolumab +/- ipilimumab in advanced solid tumors and patients with TNBC. We anticipate that the collection of blood and tumor specimens during the study will allow us to determine how these drugs are working in patients so we can develop future trials with the hope of significantly improving outcomes for patients with TNBC.
Immune targeted therapies, which stimulate the immune system to attach cancer have revolutionized cancer treatment strategies. These successes have offered new therapeutic avenues for cancer patients, especially for those with lung cancer. Despite the impressive clinical efficacy and duration of responses observed, the fraction of patients with durable responses remains in the order of 20% and there is therefore an unmet need to maximize efficacy of these treatments as well as identify the patients more likely to respond. We propose to use clinical samples from 2 novel clinical trials that combine immune targeted therapy with a different class of medicines, called epigenetic therapy. We have shown that epigenetic therapy may attract immune cells to the cancer site therefore “priming” an anti-tumor immune response. We propose to pinpoint the mechanisms that mediate response and resistance to these therapies by looking at the genetic make-up of cancer cells as well as by studying the tumor microenvironment. We believe our comprehensive, cutting-edge scientific approach linked with ongoing or soon to start clinical trials will result in immediate clinical intervention initiatives and is consistent with our mission to deliver improved treatments to patients with lung cancer.
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