Ohio Colorectal Cancer Prevention Initiative (OCCPI)
A five-year statewide initiative to screen newly diagnosed colorectal cancer (CRC) patients and their biological relatives for Lynch syndrome (LS) and other hereditary cancer syndromes has been completed, the data have been analyzed and the results have been published in prestigious scientific journals.
Funded by $4.3 million from Pelotonia, the Ohio Colorectal Cancer Prevention Initiative (OCCPI) established a network of over 50 community hospitals around the state to provide screenings for LS, an inherited genetic condition that predisposes to colorectal, endometrial, ovarian, stomach and other cancers. Those who screened positive, and selected patients who screened negative, were provided genetic testing for LS and other hereditary cancer syndromes. Identifying patients and family members with hereditary cancer syndromes can allow them to take precautionary measures to try to prevent future cancers. OCCPI Director Heather Hampel, MS, LGC, says the study enrolled over 3,300 newly diagnosed CRC patients. Of those, 143 tested positive for LS, 204 of their relatives also tested positive and another 101 CRC patients were found to have a hereditary cancer syndrome other than LS. Hampel says these findings demonstrate the value of screening early-onset CRC patients for LS. She also reports that two major papers relating to the OCCPI were published this year. A paper in the journal JCO Precision Oncology made a strong scientific argument for implementing multi-gene panel testing—as opposed to the standard Universal Tumor Screening (UTS) for DNA mismatch repair— as part of the standard of care for all CRC patients. A paper in the journal Gynecologic Oncology concluded that paired tumor and germline testing for endometrial (uterine) cancer patients with non-methylated deficient mismatch repair (dMMR) tumor may be the most efficient approach for LS screening among those patients. Also, in collaboration with Electra Paskett, PhD, MSPH, associate director for population sciences and community outreach at the OSUCCC – James, the team published the results of a study randomizing close relatives of the OCCPI CRC patients to a website intervention with and without patient navigation (PN). Published in the journal Cancer Epidemiology Biomarkers and Prevention, the study found the addition of PN to a website intervention did not improve adherence to a CRC screening recommendation overall; however, the addition of PN was more effective at increasing adherence among first-degree relatives needing immediate screening.
Beating Lung Cancer in Ohio (BLC-IO)
Researchers are relying on the same network of Ohio community hospitals that was established for the OCCPI (story on previous page) for recruiting patients in a statewide clinical research initiative that takes aim at lung cancer, the No. 1 cancer killer among men and women in the United States. Supported by $3 million from Pelotonia, the Beating Lung Cancer – In Ohio (BLC-IO) initiative is led by Peter Shields, MD, deputy director of the OSUCCC; David Carbone, MD, PhD, director of the Thoracic Oncology Center at the OSUCCC – James; Mary Ellen Wewers, RN, PhD, MPH, member of the Cancer Control Program at the OSUCCC – James; and Barbara Andersen, PhD, also in the Cancer Control Program. BLC-IO has two aims. One is to assess the impact of advanced gene testing and to provide expert advice to help each patient’s treating physician determine the best therapy for stage IV lung cancer patients in hopes of prolonging survival. The other is to improve smoking-cessation rates among smokers with lung cancer and their family members (determine the impact of centralized telephone counseling and provider support on cessation). Project leaders anticipate more than 2,000 newly diagnosed patients with stage IV non-small cell lung cancer will enroll in BLC-IO via the community hospital network. Enrollees receive free testing for more than 300 genes in their cancer specimens, and physicians who treat them receive expert support for interpreting test results and determining treatments. BLC-IO also provides smoking-cessation support for up to three years to participants and family members.
Ohio Prevention and Treatment of Endometrial Cancer (OPTEC)
Supported by $1.5 million in Pelotonia funds, OPTEC aims to recruit up to 1,000 women with endometrial (uterine) cancer from partner hospitals across the state and screen them for Lynch syndrome (LS) and other inherited genetic conditions linked to greater risk of endometrial, colorectal, stomach and ovarian cancers. Their tumor samples undergo molecular profiling to identify targeted treatments personalized to each patient’s tumor characteristics. Patients with LS and their at-risk family members will be educated about the importance of genetic testing and cancerprevention strategies based on their increased risk for LS-associated cancers. Women whose tumors have defective DNA mismatch repair will be considered for immunotherapy clinical trials for endometrial cancer. OPTEC is led by David E. Cohn, MD, MBA, chief medical officer at the OSUCCC – James, and Paul Goodfellow, PhD, of the Molecular Carcinogenesis and Chemoprevention Program, and is assisted by multiple collaborators from Ohio State (including Casey Cosgrove, MD, lead oncologist and member of the Translational Therapeutics Program) and from Nationwide Children’s Hospital (NCH) Research Institute. OPTEC will conduct its LS screening with a one-step genetic sequencing technique developed by Elaine Mardis, PhD, a geneticist at the NCH Research Institute and also a member of the Translational Therapeutics Program. Genetic profiling will help identify patients most likely to benefit from new therapies, including immunotherapy drugs that target certain proteins. OPTEC also is supported by a five-year grant awarded by the National Cancer Institute in 2018 to principal investigators Goodfellow, Mardis and Heather Hampel, MS, LGC, to study “Combined NGS Tumor-Based Detection of Germline Lynch Syndrome Mutations and Prognostic Classification of Endometrial Cancers.” This grant extends research supported by Pelotonia and supports the study of additional tumors from women with endometrial cancer.
Turning the PAGE on Breast Cancer in Ohio
The newest statewide initiative supported by Pelotonia is Turning the PAGE on Breast Cancer in Ohio (Population-Level Precision Prevention Strategies for Preventing Aggressive Breast Cancer), co-led by Electra Paskett, PhD, MSPH, associate director for population sciences and community outreach at the OSUCCC – James, and Heather Hampel, MS, LGC. This project uses a multi-level approach in 12 Ohio counties to provide breast cancer education and facilitate access to risk assessment, genetic counseling and testing, appropriate screening/ surveillance, follow-up for abnormal tests, and prompt and proper treatment for African American women who are at greater risk of breast cancer mortality. Collaborators with the OSUCCC – James include the Ohio Association of Community Health Centers, Susan G. Komen and the North Central Region American Cancer Society. Participating counties include Franklin, Fairfield, Clark, Butler, Hamilton, Lake, Cuyahoga, Lorain, Trumbull, Summit, Stark and Mahoning. Several strategies (e.g., Facebook ads, referrals from providers or community organizations) are being used to direct interested women to a website that includes educational information about breast cancer screening, prevention and treatment, and a risk-assessment tool that provides a personal prescription for breast health, including whether they need to schedule an appointment with cancer genetics professionals. Paskett says this study will use geographic predictors (county) of aggressive disease to identify and target women who live in high-risk counties, train providers at Federally Qualified Health Centers (FQHCs) to facilitate breast health strategies and deliver personalized breast cancer prevention strategies to women based on their risk stratification, and help women adhere to these strategies via telephone patient navigation. “We will determine whether there were significant increases in the percentage of women who are up-to-date with risk-appropriate breast cancer screening in the 12 counties,” she adds. “We also will determine the number of referrals to genetic counseling/genetic testing within the FQHCs, any change in breast-health knowledge among FQHC providers, and the number of community organizations involved in breast health, community events and policy efforts.”