Project Funding Details

Title: Impact of race and ethnicity on outcomes in patients with hormone receptor-positive breast cancer treated with CDK4/6 inhibitors
Alt. Award Code: 1P20CA284967-01-Sub5623
Funding Organization: National Cancer Institute
Budget Dates: 2023-09-15 to 2024-08-31
Principal Investigator: Hunter, Rodney
Institution: Texas Southern University
Region: North America
Location: Houston, TX, US

Collaborators

This project funding has either no collaborators or the information is not available.

Technical Abstract

Breast cancer (BC) is the most common cancer in women worldwide and is the second leading cause of cancer death in women. However, the advances in outcomes of BC patients have been limited to a subset of the affected population, namely European American (EA) women compared to their African American (AA) women counterparts. Despite various hormone therapies, the hormone receptor (ER/PR) positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative (HR+/Her2-) subtype of BC remains difficult to treat. Cyclin- dependent kinase 4 and 6 inhibitors (CDK4/6i) have recently emerged as a new treatment strategy. Interestingly a 2022 population-based study confirmed that while the outcomes for HR+/Her2- metastatic BC have improved since CDK4/6i were introduced in 2015, this effect is primarily driven by the improved overall survival (OS) in non-Hispanic EA patients, without significant improvement in AA or Hispanics patients. The relative contribution of genetic factors vs. medication adherence or social determinants of health (SDOH) on such outcomes is less understood. Recent efforts to address this gap include databases such as 'All of Us', designed to better understand the interplay between genetic factors and social determinants. From a functional point, our preliminary analysis of The Cancer Genomic Atlas (TCGA) data shows decreased mRNA expression of FAT1, FAT4 and RB1, the major genes involved in resistance to CDK4/6i, in AA compared to EA HR+/Her2- BC. Thus, this project will do preliminary analysis of two aspects of BC therapy resistance in AA BC patients. Aim-1 of this project will assess the impact of medication adherence and various social determinants on clinical outcomes of female BC patients treated with CDK4/6i. Aim-2 will analyze the impact of genetic variations and low expression of FAT1, FAT4 and RB1 genes on the development of resistance to CDK4/6i in AA women with BC. We will use surveys, verbal medication review and EHR documentation of medication possession to gather information related to medication adherence and social determinants that may impact compliance. We will also analyze the prevalence of germline and somatic variations and epigenetic status of FAT1, FAT4 and RB1 genes in BC patients of EA and non-EA ancestry. Using computational modeling, we will predict the functional networking of FAT1, FAT4 and RB1 low expression in AA BC patients. Using established databases, clinical information obtained from the electronic health record (EHR), and surveys exploring SDOH and medication adherence patterns, this pilot aims to generate preliminary data exploring the impact of these factors on treatment outcomes in AA vs. EA patients receiving oral targeted therapy, including CDK4/6i. Discovery of AA-centric genetic variations and the impact of low expressed FAT1, FAT4 and RB1 genes in the functional networking will be critical in pre-selecting AA BC patients that may benefit from CDK4/6i therapy.

Public Abstract

Cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) have recently emerged as a new treatment strategy for hormone receptor (ER/PR) positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative (HR+/Her2-) subtype of breast cancer (BC) patients. Recent studies suggest that their benefit may be restricted only to non-Hispanic European American (EA) BC patients, without significant improvement in African American (AA) or Hispanics patients. Using patient interviews, computational modeling and functional studies, this project will analyze the social determinants and genetic aspects contributing to CDK4/6i therapy resistance in AA BC patients.

Cancer Types

Breast Cancer

Common Scientific Outline (CSO) Research Areas

6.2 Cancer Control, Survivorship and Outcomes Research Surveillance
5.3 Treatment Systemic Therapies - Discovery and Development
4.2 Early Detection, Diagnosis, and Prognosis Technology and/or Marker Evaluation - Fundamental Parameters

Single-funder organizations
Partner	Caveat
ACS	Dollar amounts found in the ICRP database are different than what is reported in the American Cancer Society's Annual Report. The dollar amounts spent on research reported in audited reports include operating expenses of the Research Department. Additionally, the dollar amounts also exclude all grants that were cancelled after being awarded, but include money that was returned from grants cancelled in the current year that were awarded in previous years. The dollar amounts reported in the database are unaudited and include grants awarded each fiscal year, exclusive of grants that cancelled before activation.
CBCRP	The California Breast Cancer Research Program grants are awarded only to individuals or institutions in California. Grants to the University of California receive only direct funds, while grants to other institutions also receive indirect costs (overhead) at 25% or the federally negotiated rate. Collaborative awards are counted in graphs and tables by the number of co-Principal Investigators rather than the number of projects.
Komen	Dollar amounts found in the ICRP database are different than what is reported on Komen\'s website or in Komen\'s Annual Report for the following reasons: Komen commits all funds necessary to support a research grant in the year it is awarded. Therefore, Komen\'s website reports on the full amount of each grant in the year it is initiated, while the ICRP data is annualized, as described. Komen funds research grants to our Scientific Advisors (Scientific Advisory Board members and Komen Scholars) and also provides discretionary funding of research-related projects that are not traditional research grants (e.g. support of the Komen Tissue Bank, ASCO and AACR meeting support). These are included in the overall Research Program spending, as reported in our Annual Report and on our website, but are not included in the ICRP database.
NIH	NIH projects in NIH Reporter assigned to the Spend Category ‘cancer’ are included in the ICRP database from FY2005 onwards. A small number of projects are excluded if essential information is missing (primarily Project title, Institution). Previous years’ data were drawn from the NFRP and may be incomplete. Starting in FY2007 NCI reports funding supplements, etc., for each grant separately instead of including them in the main project, therefore the number of projects may differ significantly from those of previous years. Projects with a cost of $0 include those that were a no-cost extension of the grant or when funding was provided by another NIH institute or center for that FY. NCI dollars in the ICRP database are drawn from NIH reporter and may not match dollars from other NCI-only databases.
Worldwide Cancer Research	Worldwide Cancer Research is unique in that the majority of our funding is awarded to researchers in countries outside the UK. Like many UK research charities, Worldwide Cancer Research only funds the direct costs of research. This creates significant problems in making quantitative comparisons between our funding and that provided by some of the other agencies in the ICRP, which fund both the direct and indirect costs (often called overheads) of research.

UK Organizations that are part of NCRI
Partner	Caveat
NCRI (GENERIC)	NCRI submits data to ICRP on behalf of all UK NCRI members from its Cancer Research Database (CaRD). The database only includes entries where funding can be directly attributed to a set of clearly defined research objectives. This means that the CaRD only contains information on all direct research funding (project, programme, fellowship, unit and institute) financed by NCRI Member organizations, for which an abstract has been submitted and where the project is active in any given financial year (April - March). Examples of funding that are currently outside the scope of CaRD are infrastructure, meeting grants and research management support."
Breakthrough (UK)	The ICRP database includes all Breakthrough Breast Cancer\'s research spend reported through its Annual Reports & Accounts. There is some variance due to different reporting periods (1 April snapshot versus full financial year) meaning that some research spend that is already committed may not be included in the ICRP figures. Expenditure on non-research charitable activities and management support costs are excluded from the NCRI, and by extension, the ICRP dataset. For further information on Breakthrough\'s research please visit www.breakthroughresearch.org.uk or email research@breakthrough.org.uk
CR-UK (UK)	The ICRP database includes around 70% of Cancer Research UK\'s direct research spend per financial year as reported through its Annual Reports & Accounts. There is some variance due to different reporting periods meaning that some direct research spend that is planned for allocation will not be included in the ICRP figures. Expenditure on vital research services, technology transfer, meeting grants, research management support and infrastructure to support Cancer Research UK\'s activities is excluded from the NCRI, and by extension, the ICRP dataset.
Department of Health (UK)	There will always be some variance between the figures available on ICRP and the figures reported publicly by DH. There are two reasons for this. Firstly, there is variance due to different reporting periods (1 April snapshot of ICRP versus full financial year reporting by DH). Secondly, the Department\'s National Institute for Health Research (NIHR) encompasses various expenditure on NHS infrastructure for research relevant to cancer that is not in a format that it is possible to capture for ICRP.
Macmillan (UK)	The ICRP database represents about 90% of Macmillan Cancer Support\'s direct research spend per financial year. There is some variance due to different reporting periods meaning that some direct research spend that is planned for allocation will not be included in the ICRP figures. Expenditure on research management support and infrastructure to support Macmillan Cancer Support\'s activities is excluded from the NCRI, and by extension, the ICRP dataset.
Scottish Government Health Directorates (UK)	Scottish Government is committed to improve the health of the Scottish population and the Chief Scientist\'s Office (CSO) funds across a broad range of relevant disease areas. Overall, 75% of the CSO spend is committed to research infrastructure in NHS Scotland. This and much other research expenditure is therefore outside the NCRI remit and, by extension, the ICRP dataset.

Canadian organizations who are part of the CCRA
Partner	Caveat
CCRA	Caveats/limitations specific to Canadian Cancer Research Alliance organizations can be accessed here.

Difference	Detail	Impact on investment figures
Not all CCRS participating organizations are included in the ICRP.	For the period 2005–2021, CCRA submitted data to the ICRP for 35 organizations and three now defunct multi-funded initiatives (CBCRA, CPCRI, and CTCRI). Note that the Canadian Breast Cancer Research Foundation merged operations with the Canadian Cancer Society in February 2017 and Prostate Cancer Canada merged in 2020. Importantly, Alberta Innovates did not report any research projects for 2020 and 2021 due to staffing constraints. Projects within the CCRS total 30,218, of which 24,129 were reported to ICRP.	Moderate for years 2020 and 2021
Not all CCRS projects are included in the ICRP.	“Related support” grants (i.e., travel awards, workshops/symposia, LOIs, etc.) are not submitted to ICRP, but are included in reports released by CCRA. In addition, equipment/infrastructure grants through the Canada Foundation for Innovation and for other funders where the cancer relevance weighting is less than 80% are not reported to the ICRP, but are included in CCRA reports. Any project with cancer relevance of less than 20% is also not reported to the ICRP.	Moderate
Co-funded projects are listed by the administering organization.	Projects that are co-funded appear under the administering organization and are not duplicated per funder. Within CCRA reports, however, investments are reported by the actual funders.	Minor
ICRP uses a different approach to calculating annual project investment.	CCRA provides ICRP with the project budget (adjusted for cancer relevance) and start and end dates. A pro-rated calculation is used to derive annual investment. Within the CCRS, prorated calculations on the basis of annual project amounts (where those data are available) are used to calculate the annual investment.	Minor
ICRP uses different site coding conventions.	The cancer site/type codes used within the CCRS are different from ICRP site codes so results by site will vary in some instances.	Minor
ICRP has technical limitations.	ICRP has a technical limit of 12 site codes and 8 CSO codes and this requires truncation for a couple of large-scale projects within the CCRS.	Very minor
CCRA provides less descriptive information about its projects to ICRP.	Lay abstracts are submitted by CCRA to the ICRP in lieu of technical abstracts and in their language of origin. For projects without lay abstracts (and there are a significant number of these), only titles are provided. An English translation is provided alongside all French project titles to facilitate use of the search engine.	No impact on investment figures, but limits full functionality of search engine especially for organizations that do not collect/report lay abstracts.