Health Disparities

Transcript

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00:13 --> 00:14Welcome to Yale Cancer
00:14 --> 00:16Answers with your host
00:16 --> 00:17Doctor Anees Chagpar.
00:17 --> 00:19Yale Cancer Answers features the
00:19 --> 00:21latest information on cancer care by
00:21 --> 00:23welcoming oncologists and specialists
00:23 --> 00:25who are on the forefront of the
00:25 --> 00:27battle to fight cancer. This week,
00:27 --> 00:29it's a conversation about health
00:29 --> 00:30disparities in cancer with
00:30 --> 00:32doctor Kim Blenman.
00:32 --> 00:34Dr. Blenman is an associate research
00:34 --> 00:36scientist in medical oncology
00:36 --> 00:38at the Yale School of Medicine
00:38 --> 00:40where Doctor Chagpar is a
00:40 --> 00:42professor of surgical oncology.
00:42 --> 00:45Maybe we can start off by you telling
00:45 --> 00:48us a little bit more about your research
00:48 --> 00:51and what exactly it is that you've been
00:51 --> 00:53doing.
00:53 --> 00:55I'm an immunologist and clinical chemists with expertise in drug
00:55 --> 00:57discovery and clinical development and
00:57 --> 00:59in aspects of pathology as you mentioned
00:59 --> 01:01I am in the Yale Department of
01:01 --> 01:03internal medicine, section of medical
01:03 --> 01:05oncology and Yale Cancer Center.
01:05 --> 01:08Briefly, I study the immune system of
01:08 --> 01:10patients to try to understand how the
01:10 --> 01:13immune system is involved in their disease
01:13 --> 01:15and their responses to therapy treatments.
01:15 --> 01:17I have done research in Melanoma
01:17 --> 01:19and I am currently working in breast
01:19 --> 01:22cancer as part of the breast medical
01:22 --> 01:23oncology translational
01:23 --> 01:25research group.
01:25 --> 01:27Tell us some of the studies that you've been
01:27 --> 01:29doing in breast cancer looking
01:29 --> 01:32at the immune system.
01:32 --> 01:33Our work is primarily conducted
01:33 --> 01:34through clinical trials.
01:34 --> 01:36As I mentioned, our goals are to
01:36 --> 01:38really try to identify components
01:38 --> 01:40or mechanisms of the immune system that
01:40 --> 01:43will either help patients to respond
01:43 --> 01:46or respond better to therapy or help them
01:46 --> 01:48to reduce the therapy.
01:48 --> 01:52The way that we do this is
01:52 --> 01:55that we look at both genes and proteins
01:55 --> 01:58of the immune system and of the tumor
01:58 --> 02:00to accomplish our goals we use
02:00 --> 02:02many platforms,
02:02 --> 02:05research platforms such as next generation
02:05 --> 02:07sequencing to identify genes in RNA and DNA.
02:07 --> 02:10And we also use Histology to
02:10 --> 02:12identify proteins and different
02:12 --> 02:14immune and tumor cell types.
02:14 --> 02:18And with that being said,
02:18 --> 02:20my research is really
02:20 --> 02:22interested in looking at many,
02:22 --> 02:23mostly biological factors.
02:23 --> 02:25As I said,
02:25 --> 02:27they are responsible for the disparities
02:27 --> 02:29that we have in disease and therapy,
02:29 --> 02:32and I am currently working on
02:32 --> 02:33triple negative breast cancer.
02:35 --> 02:36You noted cancer
02:36 --> 02:38accounts for approximately 10
02:38 --> 02:40to 15% of all breast cancers.
02:40 --> 02:41This subtype of breast
02:41 --> 02:43cancer is estrogen receptor
02:43 --> 02:45negative progesterone receptor negative,
02:45 --> 02:49and HER 2 negative in regards to the
02:49 --> 02:51biomarkers that we use to classify the
02:51 --> 02:53type of breast cancer
02:53 --> 02:56in order to appropriately treat the cancer,
02:56 --> 02:57it's often more aggressive,
02:57 --> 03:00meaning that it grows and spreads fast,
03:00 --> 03:02and so it tends to occur
03:02 --> 03:04more often in younger women,
03:04 --> 03:07and those were the BRCA gene mutations,
03:07 --> 03:09so triple negative breast cancers have
03:09 --> 03:11poorer prognosis than other subtypes,
03:11 --> 03:13partially because treatment
03:13 --> 03:14advances have lagged behind
03:14 --> 03:16other breast cancers,
03:16 --> 03:18but although treatment options are more
03:18 --> 03:20limited than the other breast cancers,
03:20 --> 03:22there are still several offices
03:22 --> 03:24available to these patients.
03:24 --> 03:26And these individuals are treated
03:26 --> 03:28with some combinations of surgery,
03:28 --> 03:30radiation therapy or chemotherapy.
03:30 --> 03:32And right now I'm working on two
03:32 --> 03:35clinical studies and one study is
03:35 --> 03:37a retrospective evaluation of genes
03:37 --> 03:38and proteins from Histology tissue.
03:38 --> 03:40From the tumor page,
03:40 --> 03:42two more patients with these triple
03:42 --> 03:44negative breast cancers to try to
03:44 --> 03:47identify immune components or mechanisms
03:47 --> 03:49that may be responsible
03:49 --> 03:52for the variations that we see in
03:52 --> 03:54different racial and ethnic groups
03:54 --> 03:56before the patients are treated.
03:56 --> 03:58And then the other study is an ongoing
03:58 --> 04:00clinical trial that is evaluating
04:00 --> 04:01the benefit of giving our triple
04:01 --> 04:03negative breast cancer patients
04:03 --> 04:05anti PDL one immunotherapy with chemotherapy
04:05 --> 04:08before they're taken to surgery.
04:08 --> 04:12Those both sound like really
04:12 --> 04:15interesting studies and I want to
04:15 --> 04:18talk about each one of them in turn.
04:18 --> 04:21So the first one, the retrospective study
04:21 --> 04:24where you're looking at kind of the immune
04:24 --> 04:26factors in these cancers retrospectively.
04:26 --> 04:28So these are cancers that have already
04:28 --> 04:31been taken out of patients and you're
04:31 --> 04:34looking at immune factors in these cancers.
04:34 --> 04:36Now I understand that triple
04:36 --> 04:38negative cancers perhaps more than
04:38 --> 04:40other breast cancers actually
04:40 --> 04:42are immunogenic, they tend to have a
04:42 --> 04:44lot of infiltrating cells in them,
04:44 --> 04:45is that right?
04:45 --> 04:48Is that what you're looking at?
04:49 --> 04:52or are you looking at other factors as well?
04:52 --> 04:53That's absolutely right.
04:53 --> 04:54And actually
04:54 --> 04:55we're looking at all the
04:55 --> 04:57above and
04:57 --> 05:00actually we're doing as I said,
05:00 --> 05:01looking at different populations
05:01 --> 05:03of people within that particular space,
05:03 --> 05:05and the reason is because the
05:05 --> 05:07percentage of triple negative breast
05:07 --> 05:09cancers among the total breast cancers
05:09 --> 05:11diagnosed in non Hispanic whites.
05:14 --> 05:16Hispanics, American Indians or
05:16 --> 05:19Alaska Natives is between 10 and 20%.
05:19 --> 05:21I'm sorry 10 to 12% and non
05:21 --> 05:23Hispanic Blacks is 21%,
05:23 --> 05:26and so we're trying to understand why that
05:26 --> 05:29difference exists and more of the biology,
05:29 --> 05:32more of the biological questions
05:32 --> 05:34and so we're looking at the immune
05:34 --> 05:37system to see if there are different
05:38 --> 05:41immune players in terms of the amount of
05:41 --> 05:44infiltration that we see between these
05:44 --> 05:45different populations of people
05:45 --> 05:47or the type of inflation.
05:47 --> 05:49What type of cells are being
05:49 --> 05:50infiltrated in these patients?
05:50 --> 05:54And so we're doing that by
05:54 --> 05:56looking at the Histology.
05:56 --> 05:59Taking the samples of the tumor doing
05:59 --> 06:01next generation sequencing on those,
06:01 --> 06:04look at the genes and then looking
06:04 --> 06:07at different types of immune
06:07 --> 06:09cells from the Histology tissue itself,
06:09 --> 06:13as well as just using our standard
06:13 --> 06:16hematoxylin eosin to look at the
06:16 --> 06:19actual global tumor infiltrating lymphocyte
06:19 --> 06:21into these populations
06:21 --> 06:23sorry into these patients samples.
06:23 --> 06:26I want to make sure that I understood
06:26 --> 06:29because I mean it sounds like such a cool
06:29 --> 06:32project with so much there to unpack.
06:32 --> 06:33And maybe you're looking
06:33 --> 06:35at all of these questions.
06:35 --> 06:37But the first thing that it sounds
06:37 --> 06:40like you're doing is really looking at
06:40 --> 06:42these cancers to see whether
06:42 --> 06:44various immune pathways are turned on
06:44 --> 06:47or turned off in the cancer themselves,
06:47 --> 06:50whether the they have more or less
06:50 --> 06:52infiltration with the immune
06:52 --> 06:54system in these cells.
06:54 --> 06:57So do you find that there are biologic
06:57 --> 07:00differences in triple negative breast
07:00 --> 07:02cancer between African Americans,
07:02 --> 07:03and say, Caucasians?
07:03 --> 07:06And do you think that really
07:06 --> 07:08explains why African Americans
07:08 --> 07:12tend to have more triple negative
07:12 --> 07:14breast cancers than other non
07:14 --> 07:16African American races?
07:16 --> 07:18So this is one of
07:18 --> 07:22the things that we actually are
07:22 --> 07:24trying to tease out with this particular
07:24 --> 07:27study and all the data is not back yet.
07:27 --> 07:29And of course there are other factors as
07:29 --> 07:31well that contributes to those differences,
07:31 --> 07:33but as I said,
07:33 --> 07:35we're really trying to
07:35 --> 07:37focus on these differences in the
07:37 --> 07:39system that we have seen initially,
07:39 --> 07:41and as we're putting more patients on
07:41 --> 07:43these studies and look at more things,
07:43 --> 07:46we're trying to see if
07:47 --> 07:50that gives us any reason to
07:50 --> 07:52believe that there are different,
07:52 --> 07:55as I said, immune cell populations
07:55 --> 07:57that are being introduced that
07:57 --> 07:59are different between those two
07:59 --> 08:01groups and as well as other groups.
08:01 --> 08:04But also if there's maybe a difference
08:04 --> 08:06in the amount of those immune
08:06 --> 08:09cells that are being introduced,
08:09 --> 08:11and so we're still
08:11 --> 08:12evaluating the data,
08:12 --> 08:15but hopefully that'll give us some
08:15 --> 08:17insight if that's indeed true.
08:19 --> 08:21Because that would mean that
08:21 --> 08:23we may need to
08:23 --> 08:25think about how we treat the
08:25 --> 08:26patients differently, right?
08:26 --> 08:29And it may give you
08:29 --> 08:31some insight into potentially why
08:31 --> 08:33certain people get triple negative
08:33 --> 08:35breast cancers more than others.
08:35 --> 08:37Maybe some populations of people
08:37 --> 08:40automatically have a more robust immune
08:40 --> 08:42response to cancer cells as they are
08:42 --> 08:44initially beginning such that they
08:44 --> 08:46don't develop into full blown tumors,
08:46 --> 08:51and so you may be able to see differences.
08:52 --> 08:55Are you looking also at the immune
08:55 --> 08:57factors versus stage at presentation?
08:57 --> 09:00Because that too might play
09:00 --> 09:02into that whole story, right?
09:02 --> 09:03Correct, and so
09:03 --> 09:06we're looking at
09:06 --> 09:08that as well.
09:13 --> 09:15That could definitely play a difference
09:15 --> 09:18in what makeup looks
09:18 --> 09:21like at the end of the day?
09:21 --> 09:23Because we want to make sure
09:23 --> 09:26that we are comparing
09:26 --> 09:28apples to apples.
09:29 --> 09:33And so for this part of the study,
09:33 --> 09:34you're actually looking
09:34 --> 09:36at the tumors DNA, right?
09:36 --> 09:38You're taking these tumor
09:38 --> 09:40sections and doing next generation
09:40 --> 09:43sequencing on the tumor and the micro
09:43 --> 09:44environment surrounding the tumor,
09:44 --> 09:47has anybody really looked at the immune
09:47 --> 09:49system of different racial groups to
09:49 --> 09:51see whether there are differences
09:51 --> 09:54in immune cell production between
09:54 --> 09:57different races that might
09:57 --> 10:00give you some insight into
10:00 --> 10:02how people mount immune responses.
10:02 --> 10:03Whether that's the same for everybody,
10:03 --> 10:05or whether there are nuances
10:05 --> 10:06and so actually we
10:06 --> 10:08have some
10:08 --> 10:10evidence to that.
10:12 --> 10:14As you think about things like autoimmune diseases
10:14 --> 10:16autoimmune diseases tend to be
10:16 --> 10:18more prevalent in certain
10:18 --> 10:19populations,
10:23 --> 10:25and they tend to have as you
10:25 --> 10:26look at the immune system,
10:26 --> 10:28the immune systems tends
10:28 --> 10:29to be very overactive,
10:29 --> 10:31and so these are things that can
10:31 --> 10:33give us clues that maybe
10:33 --> 10:35in different populations
10:35 --> 10:37we may need to think differently
10:37 --> 10:38about how we approach this,
10:38 --> 10:40and so there are studies that have
10:40 --> 10:41been done in different fields,
10:41 --> 10:44and I think that we can utilize that
10:44 --> 10:46to try to
10:46 --> 10:48understand how this is applicable to
10:48 --> 10:49cancer as well,
10:49 --> 10:51and this is actually one of
10:51 --> 10:53the main goals of this
10:53 --> 10:54particular
10:54 --> 10:56study that we're doing is to
10:56 --> 10:57try to tease that out as well,
10:57 --> 10:59and hopefully we can expand on that
11:00 --> 11:02in terms of digging a bit
11:02 --> 11:03more deeper into them,
11:03 --> 11:04these different
11:04 --> 11:05patient populations.
11:05 --> 11:07So what I'd like to
11:07 --> 11:08look at,
11:08 --> 11:10although this particular site is looking at,
11:10 --> 11:12individuals of African descent,
11:12 --> 11:13individuals of Caucasian descent,
11:13 --> 11:15I would also like to expand
11:15 --> 11:16that to individuals of Asian
11:16 --> 11:18descent as well and
11:18 --> 11:20other populations because
11:20 --> 11:22I believe that that's actually very
11:22 --> 11:24important for us to be represented
11:24 --> 11:26in order for
11:26 --> 11:28us to understand exactly what's
11:28 --> 11:30going on with cancers globally.
11:30 --> 11:32And the other thing that
11:32 --> 11:35you had mentioned just in passing was
11:35 --> 11:38looking at different types of immune cells,
11:38 --> 11:39so we often
11:39 --> 11:42when we've been on this show,
11:42 --> 11:43have talked about these
11:43 --> 11:44tumor infiltrating lymphocytes.
11:44 --> 11:47And we talk about T cells,
11:47 --> 11:49but there are other immune factors
11:49 --> 11:51and other immune cells as well.
11:51 --> 11:54Do we have any sense of
11:54 --> 11:56how these immune cells vary in
11:56 --> 11:59terms of their response to tumors?
11:59 --> 12:01Either different types of
12:01 --> 12:03tumors or to the same tumor,
12:03 --> 12:04but in different people?
12:04 --> 12:06Actually that's a really
12:06 --> 12:09great question, and I've done some
12:09 --> 12:11work in this in breast cancer itself,
12:11 --> 12:14and so I'd like to share a little
12:14 --> 12:17bit about a study that was recently
12:17 --> 12:18published looking at breast
12:18 --> 12:20cancers in predicting disease.
12:20 --> 12:23I'm sorry B cells in predicting
12:23 --> 12:25disease free survival in breast
12:25 --> 12:26cancer patients and just as
12:26 --> 12:28a little bit of background,
12:28 --> 12:30metastasis is a frequent
12:30 --> 12:32early event in many cancers,
12:32 --> 12:34and so in breast cancer,
12:34 --> 12:36lymph node invasion is a key determinant in
12:36 --> 12:37prognosis and treatment.
12:37 --> 12:39So our previous studies have shown
12:39 --> 12:42that T cells and injured cells in the
12:42 --> 12:44tumor draining lymph nodes may be
12:44 --> 12:46altered in some breast cancer patients
12:46 --> 12:47and can predict clinical outcome.
12:47 --> 12:50But B cells are another major immune
12:50 --> 12:52cell population for their role
12:52 --> 12:54in solid cancers and is not well studied.
12:54 --> 12:56So B cells isolated from
12:56 --> 12:58tumor draining lymph nodes,
12:58 --> 12:59specifically Sentinel lymph nodes,
12:59 --> 13:02which are the first set of lymph nodes
13:02 --> 13:04that the tumor drains into
13:04 --> 13:05can recognize cancer associated
13:05 --> 13:08antigens and are capable of producing
13:08 --> 13:09antibodies against those antigens,
13:09 --> 13:11and so in our study that
13:11 --> 13:13we recently published
13:13 --> 13:15we looked at the cells,
13:15 --> 13:17and since all lymph nodes in
13:17 --> 13:18breast cancer patients,
13:18 --> 13:20we found that patients with higher
13:20 --> 13:23numbers of these had longer
13:23 --> 13:25disease free survival overall as
13:25 --> 13:27well as in those patients with
13:27 --> 13:29triple negative breast cancer
13:29 --> 13:31that had actually good prognosis.
13:31 --> 13:33Interestingly this can
13:33 --> 13:36be seen in Melanoma patients and we
13:36 --> 13:38recently also published this and
13:38 --> 13:41we have found higher numbers
13:41 --> 13:43correspond
13:43 --> 13:45to longer progression free survival
13:45 --> 13:47in patients with metastatic Melanoma
13:47 --> 13:49treated with anti PDL1 immunotherapy.
13:51 --> 13:54And so have we found a difference in
13:54 --> 13:57terms of the number of B cells that are
13:57 --> 14:00in tumors of people of African American
14:00 --> 14:03descent versus Caucasians. So this
14:03 --> 14:06is one of the things that we're
14:06 --> 14:08looking at and that
14:08 --> 14:10data is still to be evaluated.
14:10 --> 14:12Certainly,
14:12 --> 14:15if it's true that B cells do
14:15 --> 14:17predict differences in survival,
14:17 --> 14:20it sounds like it is a relatively
14:20 --> 14:22simple prognostic factor.
14:24 --> 14:27And it could give people an idea of
14:27 --> 14:30how this biology is going to play out,
14:30 --> 14:32particularly as it interfaces with
14:32 --> 14:34the immune system.
14:34 --> 14:36You're absolutely right, and
14:36 --> 14:38the other thing that I'd like to
14:38 --> 14:40point out too is that
14:40 --> 14:41the immune system is called a
14:41 --> 14:43system for a very specific reason.
14:43 --> 14:45It works as a system,
14:45 --> 14:47so B cells do not work in isolation.
14:47 --> 14:49T cells do not work in isolation,
14:49 --> 14:52and so all these things require
14:52 --> 14:54to be working together
14:54 --> 14:57and so this is one of the things
14:57 --> 14:59that we need to think about when we
14:59 --> 15:01make these prognostics and predict
15:01 --> 15:04the tools is to consider all
15:04 --> 15:05these different immune systems
15:05 --> 15:07and put them together to make
15:07 --> 15:08choices that we move forward.
15:08 --> 15:11We're going to pick up on
15:11 --> 15:13that conversation right after we take
15:13 --> 15:15a short break for medical minute.
15:15 --> 15:17Please stay tuned to learn more about
15:17 --> 15:19health disparities and cancer and the
15:19 --> 15:21immune system with my guest doctor Kim Blenman.
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15:38 --> 15:40This is a medical minute
15:40 --> 15:41about colorectal cancer.
15:41 --> 15:42When detected early,
15:42 --> 15:44colorectal cancer is easily treated
15:44 --> 15:47and highly curable and as a result,
15:47 --> 15:49it's recommended that men and women
15:49 --> 15:52over the age of 50 have regular
15:52 --> 15:55colonoscopies to screen for the disease.
15:55 --> 15:58Tumor gene analysis has helped improve
15:58 --> 15:59management of colorectal cancer
15:59 --> 16:01by identifying the patients most
16:01 --> 16:03likely to benefit from chemotherapy
16:03 --> 16:05and newer targeted agents,
16:05 --> 16:07resulting in more patient
16:07 --> 16:08specific treatments.
16:08 --> 16:10More information is available
16:10 --> 16:11at yalecancercenter.org.
16:11 --> 16:15You're listening to Connecticut public radio.
16:15 --> 16:16Welcome
16:16 --> 16:18back to Yale Cancer Answers.
16:18 --> 16:21This is doctor Anees Chagpar and I'm
16:21 --> 16:24joined tonight by my guest doctor Kim Blenman
16:24 --> 16:27and we're talking about health disparities
16:27 --> 16:30in cancer and right before the break
16:30 --> 16:32Kim, you were talking to us
16:32 --> 16:34about some of the studies that
16:34 --> 16:37you're doing in breast cancer,
16:37 --> 16:39and specifically one study in triple
16:39 --> 16:41negative breast cancers where you're
16:41 --> 16:43looking retrospectively at the
16:43 --> 16:45various immune systems and immune
16:45 --> 16:48responses that are mounted by patients
16:48 --> 16:50with triple negative breast cancer and
16:50 --> 16:54you kind of left us hanging
16:54 --> 16:57in terms of the details of whether this
16:57 --> 17:00is really different between African
17:00 --> 17:02Americans and Caucasian patients.
17:02 --> 17:04We know, for example,
17:04 --> 17:06that in triple negative breast cancer
17:06 --> 17:10it seems to be more prevalent in African
17:10 --> 17:12Americans than in Caucasian patients.
17:12 --> 17:15Can you shed some more light on how
17:15 --> 17:17different cancers affect different
17:17 --> 17:19racial groups differently?
17:20 --> 17:23Yes, and as I mentioned,
17:23 --> 17:26my research interest is in the
17:26 --> 17:28biological factors responsible for
17:28 --> 17:31disparities and disease and their responses.
17:31 --> 17:32So in that context,
17:32 --> 17:34Melanoma is a great example.
17:34 --> 17:37So Melanoma is a skin cancer that
17:37 --> 17:40occurs most commonly when the DNA in
17:40 --> 17:42melanocytes is damaged by UV rays.
17:42 --> 17:44That is sun exposure.
17:44 --> 17:46So melanocytes are the
17:46 --> 17:48cells that produce melanin,
17:48 --> 17:50which gives skin its color.
17:50 --> 17:53Eumelanin is a type of melanin that
17:53 --> 17:56is responsible for darkening the skin
17:56 --> 17:59and it has the ability to protect the
17:59 --> 18:02skin from UV damage so when individuals
18:02 --> 18:06tan as a result of exposure to the sun,
18:06 --> 18:08youe melanin is responsible for the
18:08 --> 18:12visible color that you see as the tan so
18:12 --> 18:14individuals with naturally darker skin,
18:14 --> 18:17have more eumelanin and are therefore
18:17 --> 18:19at lower risk for developing
18:19 --> 18:21UV induced skin cancer.
18:21 --> 18:22So for decades,
18:22 --> 18:25the messages that were shared in general
18:25 --> 18:28and in communities of people of color
18:28 --> 18:31with naturally darker skin was that
18:31 --> 18:33people of color do not get Melanoma.
18:33 --> 18:34However,
18:34 --> 18:36today we know that the most common form
18:36 --> 18:39of Melanoma found in individuals with
18:39 --> 18:42naturally darker skin is acral Melanoma,
18:42 --> 18:45which is often found under nails.
18:45 --> 18:49On the palms of hands and the soles of feet,
18:49 --> 18:51and disease of face.
18:51 --> 18:53The musician Bob Marley from
18:53 --> 18:55Jamaica died of acral Melanoma.
18:55 --> 18:58And so this is a good
18:58 --> 19:00example of why it's
19:00 --> 19:02important that we actually take into
19:02 --> 19:04account these biological factors and
19:04 --> 19:08try to find or look for things that
19:08 --> 19:11may give us some clues as to why
19:11 --> 19:14things are different that are not
19:14 --> 19:16a part of social determinants of Health
19:16 --> 19:20and so this is how we really got
19:20 --> 19:22interested in looking into these
19:24 --> 19:26different factors for
19:26 --> 19:27these different cancers.
19:27 --> 19:31That makes sense in in Melanoma,
19:31 --> 19:33in breast cancer we were
19:33 --> 19:35talking about before the break
19:35 --> 19:38it's a little bit more
19:38 --> 19:40tricky in the sense that there doesn't
19:40 --> 19:43seem to be a particular factor.
19:43 --> 19:45Something like eumelanin,
19:45 --> 19:47which would be different between African
19:47 --> 19:49Americans and Caucasian patients,
19:49 --> 19:52which I guess is how you
19:52 --> 19:54got into thinking about
19:54 --> 19:57why is it that triple negative
19:57 --> 20:00breast cancer is more common in
20:00 --> 20:03African American patients
20:03 --> 20:06and could this have something
20:06 --> 20:09to do with their immune system?
20:09 --> 20:11Because certainly we know that triple
20:11 --> 20:14negative breast cancers are immunogenic.
20:15 --> 20:16Exactly, and actually,
20:16 --> 20:17that's the link with
20:17 --> 20:19the acral Melanoma as well.
20:19 --> 20:21So the thing about acral
20:21 --> 20:23Melanoma is that it actually has a
20:23 --> 20:25lot of infiltrating immune cells.
20:25 --> 20:27and are a little bit less
20:27 --> 20:30involved in individuals of Caucasian descent,
20:30 --> 20:32and so
20:32 --> 20:33you're thinking about, okay
20:33 --> 20:35let's look at the immune cells.
20:35 --> 20:37You know there's something
20:37 --> 20:38different about the immune cells.
20:38 --> 20:41and the types of cells also infiltrated
20:41 --> 20:44that's making these differences that we see.
20:44 --> 20:47And I suppose you did
20:47 --> 20:49mention before the break about
20:49 --> 20:51your study looking at B cells,
20:51 --> 20:54and I believe you mentioned that you
20:54 --> 20:57found that B cells were tied to prognosis
20:57 --> 21:00in both Melanoma and in breast cancer,
21:00 --> 21:02correct?
21:02 --> 21:06I guess that leads us to the next study
21:06 --> 21:10that you had mentioned before the break,
21:10 --> 21:12which is a prospective trial
21:12 --> 21:14looking at immunotherapy because,
21:14 --> 21:17as we've talked about on the show previously,
21:17 --> 21:21and as many of our listeners may know,
21:21 --> 21:22immunotherapy actually has
21:22 --> 21:25really taken hold in Melanoma
21:25 --> 21:27and is just starting to get evaluated
21:27 --> 21:30in breast cancer and specifically in
21:30 --> 21:32triple negative breast cancer, so
21:32 --> 21:34maybe you can tell us a little
21:34 --> 21:36bit more about your work there.
21:40 --> 21:42In the last five to 10 years or so
21:42 --> 21:43you've mentioned,
21:43 --> 21:45we've started to really recognize
21:45 --> 21:47that the immune system has a role in
21:47 --> 21:48how cancer patients will respond to
21:48 --> 21:51many of the therapies that we give,
21:51 --> 21:51including chemotherapy.
21:51 --> 21:53So to take advantage of that fact,
21:53 --> 21:55we are, as you mentioned,
21:55 --> 21:56starting to identify and use therapies
21:56 --> 21:58that directly impact the immune system
21:58 --> 22:00alone or in combination with chemotherapy.
22:00 --> 22:01So, for example,
22:01 --> 22:03we have an ongoing study that
22:03 --> 22:05is evaluating the benefit of giving our
22:05 --> 22:07triple negative breast cancer patients
22:07 --> 22:10Anti PDL1 immunotherapy with
22:10 --> 22:11chemotherapy before they're taken
22:11 --> 22:14to surgery and the advantage of that
22:14 --> 22:17is that we're trying to understand
22:17 --> 22:19whether or not this
22:19 --> 22:21particular regiment of giving that
22:21 --> 22:24immunotherapy could help boost
22:24 --> 22:26the immune system's ability to
22:26 --> 22:28see the cancer or to break it down
22:28 --> 22:30so that the chemotherapy itself
22:30 --> 22:33can respond better to the cancer.
22:33 --> 22:34And, as I said,
22:34 --> 22:36the study is still ongoing,
22:36 --> 22:39but we are starting to see some
22:39 --> 22:41very interesting results that
22:41 --> 22:43have some positive benefit
22:43 --> 22:46for Anti PDL1.
22:46 --> 22:49Now how does
22:49 --> 22:50that immunotherapy work,
22:50 --> 22:52particularly for people who
22:52 --> 22:57have PD L1 or PDL or PD one
22:57 --> 23:00receptors or would it work
23:00 --> 23:02for any triple negative?
23:02 --> 23:04Actually this is
23:04 --> 23:07kind of interesting because we're
23:07 --> 23:10actually finding that we are getting
23:10 --> 23:12affected regardless of whether or
23:12 --> 23:14not the individuals have PD L1
23:14 --> 23:16as part of their tumor,
23:16 --> 23:19and so there are other things
23:19 --> 23:21going on there that are mediating
23:21 --> 23:23this response that we're still trying
23:23 --> 23:26to learn for this particular PD1
23:26 --> 23:28PD L1 Axis.
23:28 --> 23:31So it's certainly a really interesting
23:31 --> 23:34and novel thing to think about,
23:34 --> 23:37and I know many of our listeners are
23:37 --> 23:39always intrigued by immunotherapy.
23:39 --> 23:42It seems to be a really hot topic,
23:42 --> 23:45but when we think about immunotherapy,
23:45 --> 23:48one of the things that we always caution
23:48 --> 23:51patients about is the side effects,
23:51 --> 23:54which tend to be
23:54 --> 23:57side effects that are an exacerbation of
23:57 --> 24:00the immune system because essentially you
24:00 --> 24:04rev up your immune system or as you say,
24:04 --> 24:07you can make tumor cells more
24:07 --> 24:10susceptible to the immune system,
24:10 --> 24:12now have you noticed a difference
24:12 --> 24:15in terms of racial groups with
24:15 --> 24:18regards to those side effects?
24:18 --> 24:20Because you mentioned that there
24:20 --> 24:23is a racial difference in terms
24:23 --> 24:26of autoimmune diseases so
24:26 --> 24:28one would imagine that there might
24:28 --> 24:31be a difference in terms of the side
24:31 --> 24:33effects with immunotherapy as well.
24:33 --> 24:34Have you found
24:34 --> 24:36that so?
24:36 --> 24:38That's a great question and something that
24:38 --> 24:40we are actually evaluating now.
24:40 --> 24:42And so as I said,
24:42 --> 24:44the study is still ongoing,
24:44 --> 24:46so we don't have enough patients
24:46 --> 24:48collected yet in the different groups
24:48 --> 24:50to actually make any statements.
24:50 --> 24:52But this is actually something
24:52 --> 24:54that I am very interested in.
24:54 --> 24:56And is one of my
24:56 --> 24:58major goals of this study is
24:58 --> 25:01to try to tease out NOTE Confidence: 0.89420384
25:01 --> 25:04those potential differences that we see
25:04 --> 25:06between different populations of people,
25:06 --> 25:08but no, we don't
25:08 --> 25:10have that information yet,
25:10 --> 25:13but I suspect that we will be able to
25:13 --> 25:16see in these studies and other studies
25:16 --> 25:18that others are doing.
25:18 --> 25:19Do we know whether different
25:19 --> 25:21racial groups will respond
25:21 --> 25:23differently to immunotherapy?
25:23 --> 25:26For example, if patients have a
25:26 --> 25:28similar tumor in terms of their PDL1
25:28 --> 25:32status. The size of the tumor,
25:32 --> 25:35the B cells and the T cells that
25:35 --> 25:38are in the micro environment and
25:38 --> 25:40you give them immunotherapy.
25:40 --> 25:42Do we know whether,
25:42 --> 25:45just by fact of different racial groups,
25:45 --> 25:48they will Mount a different immune
25:48 --> 25:51response that will then result in
25:51 --> 25:53differences in terms of the effect?
25:55 --> 25:58So I think one of the first things
25:58 --> 26:01that we need to think about is
26:01 --> 26:04the individual and
26:04 --> 26:07for that purpose you know
26:07 --> 26:09the health of the individuals is
26:09 --> 26:11influenced by many interconnected
26:11 --> 26:13factors such as their individual biology,
26:13 --> 26:14their behavior,
26:14 --> 26:16environmental and physical influences.
26:16 --> 26:18The type of medical care that they're
26:18 --> 26:20getting and the social determinants
26:20 --> 26:22which are influenced by both the
26:22 --> 26:24socio economic and political factors.
26:24 --> 26:27And so we now know that each of
26:27 --> 26:30these factors can lead to the health
26:30 --> 26:32disparities that exist in cancer,
26:32 --> 26:35and so these are the things that we
26:35 --> 26:37actually need to consider when we
26:37 --> 26:39talk about potentially,
26:39 --> 26:41one population being
26:41 --> 26:42different than the other,
26:42 --> 26:46and so I think the individual health is
26:46 --> 26:49something that we should
26:49 --> 26:52consider versus the entire population
26:53 --> 26:54of that individual.
26:54 --> 26:58So with that being said,
26:58 --> 27:00it's going to be determinant on what
27:00 --> 27:01their biology is that individual
27:01 --> 27:04biology and how they are going
27:04 --> 27:06to respond to that individual therapy,
27:06 --> 27:08and so I don't want to generalize to an
27:08 --> 27:10entire population on that perspective,
27:10 --> 27:12but I think you know the more
27:12 --> 27:14pressing question for me is,
27:14 --> 27:17how can we overcome these
27:17 --> 27:19disparities that I just mentioned and for
27:19 --> 27:21me I think that we need to
27:22 --> 27:24do more inclusive research.
27:24 --> 27:26We need to recognize that as human
27:26 --> 27:29beings we are part of a collective that
27:29 --> 27:31is made up of different populations.
27:31 --> 27:33And then in order for us to move
27:33 --> 27:35forward in science and medicine,
27:35 --> 27:37we need to include all of our populations
27:37 --> 27:39in all of our research endeavors.
27:39 --> 27:41And this level of diversity is not only
27:41 --> 27:43required in the populations that we study,
27:43 --> 27:45but it also needs to be equally represented
27:45 --> 27:47in the faculty members that are
27:47 --> 27:49performing and or involved in these studies.
27:49 --> 27:51So again, representing the diversity
27:51 --> 27:52of our global population.
27:52 --> 27:53But again,
27:53 --> 27:55giving us some concept of the
27:55 --> 27:56individual as well.
27:56 --> 27:58Doctor Kim Blenman
27:58 --> 27:59is an associate research
27:59 --> 28:01scientist in medical oncology
28:01 --> 28:03at the Yale School of Medicine.
28:03 --> 28:05If you have questions,
28:05 --> 28:06the address is canceranswers@yale.edu
28:06 --> 28:08and past editions of the program
28:08 --> 28:10are available in audio and written
28:10 --> 28:12form at Yalecancercenter.org.
28:12 --> 28:14We hope you'll join us next week to
28:14 --> 28:17learn more about the fight against
28:17 --> 28:19cancer here on Connecticut public radio.

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October 4, 2020

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

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