Karmanos Cancer Institute receives multi-million dollar grant to determine why advanced cancer treatment fails African Americans

Research will examine racial disparities in effectiveness of immunotherapy

The Barbara Ann Karmanos Cancer Institute and Wayne State University recently received a $2,997,215 federal grant to help determine why African Americans show poorer responses than whites when treated with one of the most advanced immunotherapies for lung cancer. The specific focus of the grant is to study immune checkpoint inhibitor (ICI) treatment for metastatic non-small cell lung cancer.

The grant is through the NCI’s SPORE, or Specialized Program of Research Excellence, which funds collaborative, interdisciplinary translational cancer research. It will fund two projects under the title Reducing Cancer Health Disparities in Detroit.

Project 1: Characterizing race-specific immune profiles with respect to the tumor environment and host genetic background to determine their contribution to response to ICIs

Project 2: Understanding racial differences in patients’ responses to ICI treatment

The projects will be led by principal investigators Ann Schwartz, Ph.D., MPH, Deputy Center Director, Karmanos Cancer Institute and Professor and Associate Chair of Oncology, Wayne State University School of Medicine and Gerold Bepler, M.D., Ph.D., Thoracic Oncologist, President and CEO of Karmanos Cancer Institute.

Recent breakthroughs in immunotherapy, particularly ICIs with Food and Drug Administration approval, have offered significant advancements for lung cancer treatment. Unfortunately, African American patients have accounted for less than four percent of ICI clinical trial representation. In the limited data available, African Americans show poorer responses to ICIs than whites, contributing to racial disparities in cancer treatment.

Overall, African Americans continue to have worse outcomes after a lung cancer diagnosis than whites, and there are known differences between African Americans and whites in many aspects of cancer treatment, including time to initiation and dose of chemotherapy, symptom burden and treatment of side effects.

Poorer response to treatment and worse outcomes are compounded because lung and bronchus cancers were leading sites of cancer diagnosis among African American men and women from 2019 to 2021, according to the American Cancer Society. Lung and bronchus cancers were the number two cause of cancer death in African American people, following prostate cancer in men and breast cancer in women.

Work funded by the grant will provide the basis to move toward a more race-inclusive, equity-focused, precision medicine approach to the use of ICIs and serve as a model for future research on other cancer sites and new agents.

“With this grant, we will work to address racial disparities in Metropolitan Detroit, a uniquely important underserved population where great cancer disparities exist,” said Ann Schwartz, Ph.D., MPH, Deputy Center Director, Karmanos Cancer Institute and Professor and Associate Chair of Oncology, Wayne State University School of Medicine, one of two principal investigators for the study. “Racial disparities in cancer outcomes will likely widen without a comprehensive understanding of the biologic mechanisms driving treatment response in diverse populations and the applicability of clinical guidelines to all populations.”

In their efforts to understand racial treatment-response differences, researchers will directly evaluate sociodemographic, individual and disease-specific predictors of response to ICI treatment in African American and white patients. While ICIs hold promise for improved outcomes, little is known about whether potential predictors of patient-reported side effects and quality of life and immune-related adverse events vary by race.

By identifying drivers of potential disparities, health care professionals can better identify patients at high risk for side effects and immune-related adverse events, which are a significant concern. Health care providers can also develop interventions to reduce risk factors, thereby improving patients’ quality of life and reducing racial disparities in outcomes.

Unfortunately, little is known about potential racial differences in response to ICI treatment. This is largely due to a lack of inclusion of African American patients in the clinical trials leading to FDA approvals. Thus, there is a critical need to explore whether African American and white patients are affected differently by side effects related to ICI treatment.