Michael Hoerger, PhD, MSCR, credits a multidisciplinary collaborative team, including doctoral student Laura Perry, MS, (left) with the award of a major American Cancer Society research grant to help metastatic cancer patients better understand and access palliative care. (Photo by Paula Burch-Celentano)
The American Cancer Society has funded over 100 research grants at Tulane over the past 70 years. Their latest — a four-year, $792,000 award to Michael Hoerger, PhD, MSCR, assistant professor of psychology, psychiatry and oncology — is the largest to the University in the past decade and third largest of all time. It is meant to help metastatic cancer patients better understand and access palliative care.
Palliative care involves a multidisciplinary team that aims to improve quality of life for seriously ill patients and their families. Dr. Hoerger’s research shows that palliative care reduces the emotional and physical burden of cancer, but few patients have heard of it or how it can help, and therefore most never seek it out. And some even fear it.
Through previous research - supported in part by pilot awards from the Louisiana Clinical and Translational Science Center, the Louisiana Cancer Research Center, and the Louisiana Board of Regents - Hoerger's team found that an educational webpage greatly improved attitudes toward palliative care. Then - through the use of talented voice actors and principles of psychology and marketing - they adapted that intervention into a video suitable for viewing on a tablet in clinical settings. The video was developed with input from patients, caregivers and oncologists and provides local information on palliative care, is sensitive to the emotional context, and is tailored to the patient’s levels of education and health literacy. In pre- and post-clinical pilot studies on the video, the team found preliminary evidence of its efficacy in improving palliative care understanding and attitudes.
This ACS award will expand upon these preliminary findings by funding a randomized clinical trial to begin this fall. The trial will enroll 172 racially and socioeconomically diverse metastatic cancer patients in the New Orleans area. Control participants will receive usual care and additional healthcare-related brochures. Intervention participants will receive usual care plus the video. Family caregivers can join if desired.
"We will track patient-reported outcomes and palliative care utilization for six months," said Dr. Hoerger. "If effective, we plan to conduct a follow-up study rolling out the intervention broadly to improve palliative care utilization nationwide. Our hope is that this grant will revolutionize serious illness care by shifting people’s mindsets from fearing palliative care to embracing it.”
As a clinical health psychologist, Dr. Hoerger leads the health psychology doctoral concentration in the Department of Psychology. He says this project would be impossible without extraordinary multidisciplinary collaborators, including Sonia Malhotra, MD, MS; John Lefante, PhD; Oliver Sartor, MD; Laura Perry, MS, and many talented undergraduates.
As the Director of Palliative Medicine & Supportive Care at University Medical Center, Dr. Malhotra notes, “The work that Dr. Hoerger is focusing on is vitally important to ensure patients with metastatic cancer have access to palliative medicine, which focuses on quality-of-life challenges, including symptom management, communication and emotional support”
Dr. Reza Izadpanah is an assistant professor of medicine at Tulane University School of Medicine (Story by Carolyn Scofield)
Researchers at Tulane University School of Medicine identified a gene that causes an aggressive form of breast cancer to rapidly grow. More importantly, they have also discovered a way to “turn it off” and inhibit cancer from occurring. The animal study results have been so compelling that the team is now working on FDA approval to begin clinical trials and has published details in the journal Scientific Reports.
The team led by Dr. Reza Izadpanah examined the role two genes, including one whose involvement in cancer was discovered by Tulane researchers, play in causing triple negative breast cancer (TNBC). TNBC is considered to be the most aggressive of breast cancers, with a much poorer prognosis for treatment and survival. Izadpanah’s team specifically identified an inhibitor of the TRAF3IP2 gene, which was proven to suppress the growth and spread (metastasis) of TNBC in mouse models that closely resemble humans.
In parallel studies looking at a duo of genes - TRAF3IP2 and Rab27a, which play roles in the secretion of substances that can cause tumor formation – the research teams studied what happens when they were stopped from functioning. Suppressing the expression of either gene led to a decline in both tumor growth and the spread of cancer to other organs. Izadpanah says that when Rab27a was silenced, the tumor did not grow but was still spreading a small number of cancer cells to other parts of the body. However, when the TRAF3IP2 gene was turned off, they found no spread (known as “metastasis” or “micrometastasis”) of the original tumor cells for a full year following the treatment. Even more beneficial, inhibiting the TRAF3IP2 gene not only stopped future tumor growth but caused existing tumors to shrink to undetectable levels.
“Our findings show that both genes play a role in breast cancer growth and metastasis,” says Izadpanah. “While targeting Rab27a delays progression of tumor growth, it fails to affect the spread of tiny amounts of cancer cells, or micrometastasis. On the contrary, targeting TRAF3IP2 suppresses tumor growth and spread, and interfering with it both shrinks pre-formed tumors and prevents additional spread. This exciting discovery has revealed that TRAF3IP2 can play a role as a novel therapeutic target in breast cancer treatment.”
“It is important to note that this discovery is the result of a truly collaborative effort between basic science researchers and clinicians.” Izadpanah continued. Members of the team included Eckhard Alt, David Jansen, Abigail Chaffin, Stephen Braun, Aaron Dumont, Ricardo Mostany and Matthew Burow of Tulane University. Dr. Bysani Chandrasekar of the University of Missouri has joined in the Tulane research efforts and found that targeting TRAF3IP2 can stop the spread of glioblastoma, a deadly brain cancer with limited treatment options. The team is now working on getting FDA approval and hopes to begin clinical trials soon.
The Kay Yow Cancer Fund®, in partnership with The V Foundation for Cancer Research, has awarded Tulane Cancer Center a $100,000 grant to enhance cancer clinical trial awareness and outreach among minority patients.
Aniko Vigh, MD, director of Tulane Cancer Center's Office of Clinical Research, is principal investigator on the project. "Tulane clinical faculty serve a diverse population that is largely ethnic minority - 60% African American, 6% Hispanic, and 3% Asian," said Vigh. "Although Tulane has a history of strong enrollment of ethnic minority patients into clinical trials, participation is declining, and only 25% of total accruals for 2019 were minority patients."
It's important that participants in clinical trials represent as closely as possible the population of patients that will ultimately use the medical products being studied, because people of different ages, races and ethnicities may react differently to various medications. However, this is often not the case; racial and ethnic minorities are chronically underrepresented, due largely to lack of communication, misconception of clinical research and limited funding for education and outreach.
"Health disparities in general is a major area of emphasis for the Tulane Cancer Center, and this declining enrollment is a priority issue," said Vigh.
Integral to the proposed project is a patient navigator with extensive training in cultural competence assigned specifically to cancer clinical research. The navigator will help identify and approach prospective study patients; build a close relationship with them, their caregivers and family members; and serve as an essential link between the patient and the study team.
The navigator will be fully integrated into how each trial will be explained, including the inclusion/exclusion criteria; the therapeutic options for the patient; the benefits, risks and uncertainties of participation in the trial; the placebo arm (if any); the costs associated with participation (if any), etc. The navigator will also explain the types of trials available, how approaches to clinical research have changed over time and that participation is voluntary.
"Approaching minority patients can be challenging. Some still remember past abuses, like the Tuskegee experiment," said Vigh. "The clinical research navigator will emphasize that today’s clinical trials are federally regulated and that codes and ethics are in place to protect clinical research participants from harm."
Once a patient is enrolled, the navigator will work with the research team to retain patients on studies. He/she will help to make clinical appointments, send reminders to patients and navigate them through the clinical environment, as well as help with other needs, including transportation, lodging arrangements, caretaker education, billing and insurance issues, etc.
"Historically, Tulane Cancer Center has achieved strong enrollment into clinical trials among uninsured and ethnic minority patients when proper support personnel have been in place," said Vigh. "Funding for a clinical research navigator will enable us to fulfill our commitment to provide state-of-the-art cancer treatment and prevention trials to minority patients and the socio-economically disadvantaged population in New Orleans and the surrounding Gulf Coast community. We are enormously grateful to the Kay Yow Cancer Fund and The V Foundation for making this possible."
Annually, the Kay Yow Cancer Fund supports a cancer research-based grant in the host city of the NCAA Women’s Final Four. New Orleans was to have been the host city of the 2020 tournament prior to its cancellation due to the COVID-19 pandemic. The Kay Yow Cancer Fund works in collaboration with The V Foundation Scientific Advisory Board to identify and review grant proposals supporting women’s cancer research.
The late Kay Yow, former North Carolina State University head women's basketball coach, was first diagnosed with breast cancer in 1987 and battled the disease until her passing in 2009. In the midst of her fight, she gave her final and lasting gift — the Kay Yow Cancer Fund. In the 12 years since the Fund's inception, $7.78 million has been awarded to scientific research grants and programs that serve the underserved in the fight against ALL cancers affecting women.
A Drosophila tumor induced by Dr. Wu-Min Deng's research team helps to answer questions about how cancerous cells form, grow and metastasize. (Photo provided by Dr. Deng.)
What can the common fruit fly teach us about cancer?
"Over the last few decades, the fruit fly - Drosophila melanogaster - has become a successful model for studying human cancers," said Wu-Min Deng, PhD, professor of biochemistry and molecular biology and the Gerald and Flora Jo Mansfield Piltz Professor of Cancer Research.
In fact, Deng says many cancer-related genes in humans are named after genes in flies, where they were first identified, and the model is helping to shed light on how tumors form, how they migrate, and how they behave.
"It's not a well-known model for cancer studies, because they don’t look like humans," said Deng. "There are even oncologists who don't realize we are using a fly model for basic cancer research, but the genetic simplicity and vast arsenal of genetic tools available in Drosophila provide a unique opportunity to address questions regarding cancer initiation and progression that would be extremely challenging in other model systems."
The simplicity of the Drosophila model is just one of its advantages, according to Deng. While its genetic makeup is much simpler than other organisms, many of the genes and pathways involved in human disease, particularly cancer, play similar roles in the fly, making it an excellent option for biologic discovery. Their systems are easier to manipulate, allowing researchers to generate mutations and target overexpression more easily. And because their life cycle is very short and they reproduce quickly, Deng's team can induce tumors to grow within a couple of days and manipulate fly larvae to carry the same tumor as the parent.
The Deng Lab's recent work involving isolating Drosophila ovaries for genetic sequencing of the various cells involved in oogenesis was recently featured on the home page of the online journal PLOS Biology.
"We use a few different fruit fly tissues to model growth regulation and tumor formation," said Deng. "Ovary is one. Ovaries produce functional eggs for the next generation. The process is very elaborate and involves interaction between several different cell types within the organ. But the process is also regulated by other systems, so this collaboration can be analyzed. We study what kind of cells types are there, the different genes expressed, and what kinds of signaling might be involved. We feel this project will be a good resource to the field. Anyone who wants to use this model to do any type of developmental or cancer studies can refer to our paper."
Deng moved his lab to Tulane from Florida State University a little less than a year ago. Since his arrival, he has begun to explore opportunities to interact and hopefully collaborate with fellow Tulane researchers using other model systems. His team is currently working on a new manuscript looking at how cell growth is regulated normally and how disruption can lead to tumor formation in the Drosophila model. "I am very fortunate to have a group of people in my lab who have worked tirelessly to make this project possible," said Deng.
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Thanks A Million!
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