All cancer patients should have the opportunity to get very good care through research studies. Research studies are important to make cancer treatments and survival from cancer better but very few people of color are treated on cancer research studies called clinical trials. One way to solve this problem is to use specially trained staff to help cancer patients better understand clinical trials. These staff are called patient navigators. In this project, we will use patient navigators to teach and support patients asked to be in a cancer research study. These navigators will work as a team to make sure that all African Americans who receive care at the Cancer Center are considered for a clinical trial. In order for the patient navigator to know which patients may be fit to participate in research, we will use information from the medical record to create a list of patients that could be asked about their interest to get treatment with a clinical trial. The patient navigator will use this list to contact patients and will teach patients about clinical trials and connect patients to finance counselors, social workers and other helpful community services as needed. To understand if the project is a success, we will compare the total number of patients, by race, treated on a cancer research study before and after the project.
Funded in partnership with The Leukemia & Lymphoma Society’s PedAL Initiative and the Wine Celebration Fund-A-Need
Acute myeloid leukemia is a cancer of bone marrow cells. It can be difficult to treat, particularly in young patients. The disease can differ from one patient to another, depending on the kinds of mutations that are found in the cancer cell. Different mutations may respond to different treatments.
Dogs also develop acute leukemia. In this species the outcomes are dismal, with most dogs being euthanized within days of the diagnosis because of poor quality of life. Currently available chemotherapy is ineffective in this species.
In this project we will sequence DNA and RNA from 100 cases of naturally occurring acute leukemias in pet dogs. Our goal is to find mutations and gene expression patterns shared between dogs and people. Once these shared features are identified, new treatments can be devised which can be tested first in dogs, and if successful, translated to humans. This approach offers a chance at better therapies in both species.
Clinical trials offer a path to cure for cancer patients by testing methods to prevent, find or treat many types of illness. Yet, patient access to clinical trials varies; rural areas have limited health care services. Duke University has a wealth of clinical trials for patients with cancer. The goal of this effort is to increase the clinical trials available from Duke to the community. The clinical trials will focus on specific ethnic groups in specific locations. Two types of clinical trials will be the focus: Uncommon cancers– such as blood-based cancers, or cancers that have different effects on specific races – such as prostate.
Duke doctors with special knowledge in Prostate Cancer and blood cancers will go to specific clinics. The Duke doctors will talk with doctors and nurses in the community about patient cases. We will test to see if rural clinics can use central storage for test results from tumors. Central storage will let us match test results from tumors to available clinical trials.
Our team wants to include patients in our effort to improve knowledge about clinical trials. We want to help make them aware that clinical trials are available. A committee that includes patients will help guide the creation of educational tools for patients.
Prostate cancer afflicts one in seven men and is their second leading cause of death, justifying development of more effective therapies. Prostate cancer depends on testosterone binding to and activating the androgen receptor (AR), which in turn promotes the growth of prostate cancer. Current therapies for prostate cancer are aimed at reducing AR activity, either by blocking the production of testosterone or through agents which compete with testosterone for binding to the AR. Our approach is depleting cancer cells of the AR protein by promoting its degradation. We will accomplish this by manipulating the pathways (either genetically or with drugs) which control protein degradation. Our preliminary data show that we can promote degradation of the AR in cells in test tubes. In this proposal we will test if we can promote AR degradation in mouse models of prostate cancer.
Funded by the Dick Vitale Pediatric Cancer Research Fund
Only half of children with neuroblastoma that is found to be “high-risk” (HR-NB) live after getting the best known treatments. To change this, we need to know what makes HR-NB grow, and find new targets to attack. The New Approaches to Neuroblastoma Therapy (NANT) (www.nant.org) is a team of doctors working with patients and/or in labs to find new treatment ideas and test them in children whose tumor didn’t go away after getting the best known treatments. If NANT’s new treatments are safe and make some tumors get smaller, they are then tested in more children to see if the new treatment is better than the best-known treatments. A little blood, bone marrow, and tumor are also taken from patients on NANT treatments to study in labs to see why our new idea did or didn’t work, and how we can make them better. There are 18 NANT hospitals in the United States, Canada, Australia, and Europe. NANT is the only group working only on new/better HR-NB treatments. This grant will support NANT doctors, labs, and the people who work in the NANT office to quickly take new ideas from labs and turn them into treatments being given to children with HR-NB. It also helps us to store patient samples so they can be used to keep finding new and better ideas. Our goal is to find safe treatments that will help more children with HR-NB to live.
Funded in partnership with Cannonball Kids cancer Foundation, in memory of Tyler Trent
Glioblastoma (GBM) is the most aggressive and devastating brain tumor, and it currently has no known cure. Less than 20% of young adults diagnosed with GBM survive more than 24 months. GBM can resist treatment in many ways. These include expressing an enzyme called CD73 and changing the expression of proteins on its surface. Natural killer cells are able to fight and kill GBM, however this ability is often blocked around growing GBM cells. In order to rescue the activity of these cells, we are developing new immunotherapies by genetically modifying natural killer cells to shut down ways that GBM uses to grow. We are also combining these cells with drugs that can help them travel deeper into tumors. This immunotherapy is an entirely new way to treat GBM and has significant promise, for patients, over traditional treatments.
Funded in partnership with the Goldberg Family Foundation
We need better tools to screen for and diagnose cancer earlier and at a curable stage in individuals that carry inherited mutations such as BRCA1/2 and other cancer susceptibility genes that put them at highrisk for breast, ovarian, prostate, pancreatic and other cancers. We propose to use powerful new approachesfor “next-generation” DNA sequencing from standard blood samples to identify circulating tumor DNA mutations as a very sensitive markerof early cancers in high-risk individuals. These “liquid biopsies” may prove to be a far easier and more sensitive way to screen for cancer than our current imaging based approachesusing mammograms, MRI’s, etc. To this end, we have been collecting blood samples from our genetically high-risk patients with and without cancer, and before and after prophylactic or cancer surgeries, for liquid-biopsy analyses using technology developed at Stanford.
In 2018, 81,000 people were diagnosed with bladder cancer (BC) in the US and 17,000 people died from this disease. Three of every four new cases have an early stage of disease, called non-muscle invasive bladder cancer. This type of BC is treatable, but for over half of these patients the cancer keeps coming back and so these ‘high-risk’ patients need additional treatments. Today, we do not know which patients will have their cancer return and so we need to develop a way to know in order to help them sooner. Several cancer causing chemicals are associated with BC and so to help reduce new BC cases we need to identify and remove these chemicals from our environment. A new approach is necessary to tackle BC and our group has shown that our pet dogs can help. Each year in the US, over 60,000 dogs are diagnosed with BC. In this study, our team at NCSU College of Veterinary Medicine and Duke Cancer Institute will look for shared genetic changes in canine and human BC that may provide clues to why these cancers keep returning and how to prevent them. Our dogs live with us and so we will also study whether dogs with early BC share common chemical exposures in the home. This study of canine and human BC will allow us to determine how much help our pet dogs can provide us in looking for new ways to improve BC treatment for both ourselves and for them.
African Americans have the highest percentage of new cancer cases in the United States and the worst outcomes. Other diverse populations have difficulty getting to a cancer treatment center or need help figuring out the system one they arrive. Some people die from cancers that can be prevented or treated, simply because they are not aware of all of the treatment options. Cancer care can be very difficult because many times a patient has more than one doctor who is part of their care team. This can be scary and may make some people choose not to get cancer treatment, even if they can be cured. WFBCCC wants to make sure that everyone has access to the best cancer care possible. This may include patients participating in research that may improve outcomes for them but also may help provide information that can help tailor treatments for the next generation of cancer patients. It is important to make sure all populations are represented in studies that look at new treatments or supports for cancer patients. To meet that goal, we created a population health navigator program- people who are from the community who can help people learn about cancer, how to prevent it, what screening is required and what treatments are available. If someone is diagnosed with cancer, the navigator will assist that person by helping to remove barriers to care and will talk with patients about clinical research as part of their care.
Approximately 80,000 Americans will be diagnosed with bladder cancer in 2019 and 18,000 will die from their disease this year. Recent studies show that bladder cancer cells often carry a high number of genetic mutations which correlate with anti-tumor immune responses. New drugs known as immune checkpoint inhibitors (ICI), have produce dramatic clinical responses in up to 25% of bladder cancer patients, by enhancing anti-tumor immune responses that help control the tumor. However, despite intense efforts, biomarkers that predict response to ICI remain elusive. Furthermore, the mechanisms responsible for resistance to ICI are unknown. Predicting which patients respond to ICI would enable responders to be streamlined to receive ICIs, and resistant patients to receive alternative or combination therapies to improve their outcome. Pet dogs also develop bladder cancer that shares similar clinical, biological and genetic features with human bladder cancer. Despite standard of care treatment, most dogs will die of their disease within one year of diagnosis. Here we will investigate the genetic mutational burden in canine bladder cancer and determine whether it also correlates with tumor immune profiles. We will develop a canine ICI that can be used therapeutically in dogs with bladder cancer and we will determine whether effective ICI therapy is associated with enhanced anti-tumor immune responses and which factors or combination of factors predict ICI response. This work aims to establish the dog as a valuable model for human bladder cancer, provide a novel treatment for these dogs and guide biomarker discovery for humans.
