Lung cancer is the leading cause of death from cancer in the United States. When lung cancer is found before it spreads to other parts of the body, it can be treated and people can live longer.
There is a screening test for people who are at high risk for lung cancer. People who are over 50 and have smoked may be able to get screened. However, less than 6% of Americans in this group have been screened for lung cancer. People may not be screened because they do not know about lung screening or are worried about being screened. This project will create educational materials to help people understand if they are eligible for lung cancer screening, explain the benefits and risks and help them talk to their doctor. Education will be made available by video, in print and by website. We will test the materials using a survey. The survey will help us learn how people like the materials and if they learned about lung cancer screening.
Funded in partnership with Miami Dolphins Foundation
Lymphoma is one of the most common cancers in the United States. People who are diagnosed with lymphoma often receive chemotherapy treatment, which can cause a lot of physical and emotional side effects. Although lymphoma is common, not that much is known about how nutrition or physical activity could help lymphoma patients.
Because so little is known, this research study plans to first explore if nutrition and exercise is something that lymphoma patients are interested in and able to do during chemotherapy. Secondly, this research study will look into whether the nutrition and exercise plan helped patients with the side effects of chemotherapy on their body, mind, and quality of life.
New treatments for cancer patients are developed through studies called clinical trials. All cancer patients should understand what treatment options are available to them, including clinical trials. However, few patients are treated on clinical trials. Minority groups are even less likely to be treated on clinical trials. One way to encourage more diverse participation is to offer education. We will create a short video that shows the basics of clinical trials. The video will include diverse patients and doctors from UNC that have experience with clinical trials. The video will teach cancer patients about the basics of clinical trials and encourage them to ask their doctor if a trial could be right for them. We will also place printed materials in waiting areas for patients to take home and discuss clinical trials with their family and caregivers.
Funded in partnership with Miami Dolphins Foundation
Our goal is to make sure all women with cancer get medical care that is consistent with what is important to them, no matter their race and ethnicity. To do this, we will work together with community health workers, who are trusted professionals that help connect people from their communities to medical care through education, support, and advocacy. Our past research shows that community health workers want to help cancer patients get the right care. They can do this by having conversations about advance care planning, which is a way for patients to think about the kind of medical care they would want if they became too sick to speak for themselves. However, community health workers need more training to have these conversations with patients. We will create a program to teach community health workers how to help patients with advance care planning. Next, we will improve the program by getting feedback from community health workers and making changes based on their suggestions. Finally, we will test this program by having community health workers have advance care planning conversations with cancer patients based on what they learned. We will then get feedback from both the patients they talk to and the community health workers to find out whether these conversations were useful. In the future, community health workers could work together with doctors to make sure that cancer patients get the right medical care so that they live as well as possible during their cancer journey.
Funded in partnership with Miami Dolphins Foundation
Sarcomas are cancers of the bone and muscles, often seen in children and young adults, which are very hard to treat with very few patients surviving. Our aim is to improve treatment options for these patients. A vaccine trial using patient’s dendritic cells which are a type of immune cells, modified to identify and attack the individualized cancer was conducted at Sylvester comprehensive cancer center in 2019. Surprisingly, we noted good response in a few patients, who remain cancer free over 2 years from receiving the vaccine treatment. Therefore, the aim of this research proposal is to study the immune/non-immune cells of the surgically removed tumors and blood of patients treated on this trial. Using special high-resolution imaging methods in which key immune markers are tagged in the tissue, we will describe the immune cells in each patient’s cancer environment and correlate these to whether the patient did or did not respond to the cancer vaccine. We will also measure key immune cells in the blood of these patients collected after vaccine treatment and compare this with response to the vaccine. These detailed immune studies on patient tissue and blood samples will then guide future anti-sarcoma cancer vaccines and potential immune cell therapy to cure these aggressive cancers.
Breast cancer is the most common cancer in women in the United States and second leading cause of cancer death. When a woman is diagnosed with metastatic breast cancer (MBC) (cancer that has spread to other parts of the body) she has a less than 30% chance of surviving 5 years. These statistics remain despite decades of research and many new treatments for MBC. This suggests that we need better ways to administer drugs for MBC.
Hormone receptor positive (HR+) breast cancer is fed or fueled by estrogen and progesterone, the natural hormones of the body. HR+ MBC is initially treated with drugs that block the estrogen and progesterone production in the body. However, eventually cancer cells can become “resistant” to these hormone blocker drugs, most commonly by developing a “mutation” in the receptor of estrogen called ESR1. Once this mutation develops, the treatment is more challenging and usually involves use of chemotherapy which can lead to patients feeling sick and having multiple side effects from treatment.
In this proposal we plan to enroll HR+ MBC patients who have already developed an ESR1 mutation and offer a novel way of targeting this mutation. This will help extend time on treatment with minor side effects and possibly increase survival. We will do so by creating vaccines out of their own immune system that will allow them to wake up and engage in the fight against their cancer. This treatment will be combined with standard of care hormone blocking therapy.
North Carolina (NC) has the largest American Indian population east of the Mississippi River. Many American Indians in NC smoke cigarettes, which can lead to lung cancer. Yet, we do not know much about the needs of NC American Indians related to tobacco use and lung cancer. Three NC cancer centers joined together in 2021 to learn more about how to help American Indians improve cancer outcomes. In this study, we will first explore how often American Indians use treatment to help them quit tobacco. We will also explore whether they have been screened for lung cancer and what cancer treatments they receive. Second, we will ask American Indian community members about quitting tobacco, lung cancer screening, and their healthcare. Finally, we will work with American Indian community members to modify a quit smoking program to make it more relevant to them. We will also work with them to modify materials that tell people about lung cancer screening. This information will help American Indians by helping them quit tobacco and detect lung cancer sooner, which will help improve the health of American Indians in NC.
Funded by the Dick Vitale Pediatric Cancer Research Fund
Diffuse midline glioma (DMG) is a fatal pediatric brain tumor, striking 200-400 children in the U.S. each year. Most children with DMG survive <1 year and have no proven therapies beyond radiation. A series of new drugs are being tested in clinical trials of DMG patients, but we lack sufficient tools to track how well they work. Cancer is a rapidly moving target as it can mutate to evade the onslaught of anti-cancer drugs; thus, tumors must be analyzed repeatedly during treatment to assess therapy response. Today’s standard of care for DMG is limited to frequent imaging (MRI), which provides insufficient data to assess therapeutic response. By advancing a new blood-based assay specific to DMG, we aim to dramatically improve our ability to track the effects of treatment on this devastating disease. We will exploit extracellular vesicles (EVs) — small “bubbles” shed by cells — as surrogate markers of therapy response in DMG patients. EVs contain molecular contents (e.g., protein, RNA, DNA) from their mother cells. Tumors shed large quantities of EVs into the bloodstream, offering a potential new way to monitor treatment in DMG patients. We will develop a new assay platform that integrates cutting-edge developments in materials, optics, and deep learning AI into a single system for efficient EV analysis and test whether our platform reliably predicts drug response in DMG patients. Our approach has the potential to transform DMG therapeutic trials and clinical practice, and its flexibility may lend itself to other types of pediatric and adult cancers.
Funded by the Dick Vitale Pediatric Cancer Research Fund in honor of Beau Christensen
Primary brain tumors are the most common solid tumors in children. They are also the most frequent cause of cancer-related death in children and teens. Genetic profiling is an important tool in the treatment of these tumors. DNA sequencing provides information for proper diagnosis. It can also be used to understand how tumors change over time and to monitor response to treatment. However, performing biopsies is very challenging for brain tumors. Many tumors are in important areas of the brain and can’t be fully removed or repeatedly sampled.
“Liquid biopsy” is a new tool that can be used to diagnose cancer and track response for some systemic tumors. It works by detecting small pieces of DNA that break off from tumors. These can be found in the cerebrospinal fluid (CSF) and in blood (circulating tumor DNA, ctDNA). Accessing these “liquids” is usually easier and has fewer complications than surgery.
We previously showed that CSF ctDNA can be used to diagnose brain tumors and that ctDNA is associated with active disease. But there are instances where CSF ctDNA is not informative due to technical limitations. We propose to improve how these samples are analyzed so CSF liquid biopsies can help more patients. Our prior work was retrospective. For this project, CSF ctDNA monitoring will be added to a clinical trial. We will investigate whether there is a relationship between CSF ctDNA and disease burden. Validating CSF liquid biopsy could greatly improve how pediatric primary brain tumors are diagnosed and treated.
Funded by the Dick Vitale Pediatric Cancer Research Fund
The bone cancers Ewing sarcoma and osteosarcoma are some of the most common solid tumors occurring in children and young adults. When these tumors spread outside the bone where they start (metastatic disease) or they come back after initially going away (relapse), they are very aggressive and nearly impossible to cure. New treatments are urgently needed. CAR T cells are a type of therapy that uses a patient’s immune system to attack their cancer by recognizing a target on its surface. This target must be minimally expressed on normal cells to prevent toxicity. We have identified a target B7-H3 as being highly expressed on Ewing sarcoma and osteosarcoma and will now run a clinical trial testing antiB7-H3 CAR T cells in those diseases. We will also re-engineer these CAR T cells to be more effective in potential future trials.
