Center for Gastrointestinal Cancers Annual Lectureship: "Colorectal Cancer Disparities: Understanding Biological & Environmental Interactions"

Transcript

• 00:00Young presentation that I have
• 00:02lined up here right back to
• 00:05the share screen and let's see.
• 00:07I guess this is the one share.
• 00:11Let's see here we go and
• 00:14then we connected this.
• 00:15There we go. Excellent
• 00:18Doctor Chris Korea.
• 00:19So nice to see you so we I did I did
• 00:24your lovely intro before but and we
• 00:27have actually I will just say verbally
• 00:29but we have a plaque to give you.
• 00:31You are actually officially our
• 00:34inaugural annual speaker for
• 00:36our new Center for GI cancers,
• 00:39so we're happy to invite you and.
• 00:42Really excited to hear you today so.
• 00:45And we appreciate everyone who
• 00:48waited and I think Doctor Cruz
• 00:50Correa will probably need to end.
• 00:52Maybe like 5 minutes before
• 00:55the hour or 10:10.
• 00:57I mean, if you, I'll let you figure that out.
• 00:58We'd love to have time for questions,
• 01:00but if not, we understand.
• 01:01Alright.
• 01:02Yeah, wonderful and well, I'll do.
• 01:04You know, the last part I can skip.
• 01:06And yes, I'll stop more or less when
• 01:08I see that the time it's it's there.
• 01:10So we have about 2025 minutes.
• 01:11OK, well, so good afternoon to everyone
• 01:14and and thank you very much for.
• 01:16Dealing with the with life right?
• 01:19I mean we plan many things in our lives
• 01:21and there are things that you learned.
• 01:23I think the older that we get that
• 01:25there are things that you can control.
• 01:26That there are things that you cannot control
• 01:28so later and I'll tell you what happened.
• 01:29But you know, the good news is that
• 01:31we're here and I'm delighted and
• 01:33honored to be part of this presentation.
• 01:35So briefly, address some of the concepts
• 01:38that our group have been working on
• 01:40for the last years over a decade.
• 01:42At this point,
• 01:43and we have been focusing on Latinos and.
• 01:47Family communities,
• 01:47and specifically in GI cancers,
• 01:49and I'm going to, you know,
• 01:51narrowed the topic to colorectal
• 01:53cancer as one of the areas that
• 01:56we have been no witness of,
• 01:58the disparities that we have seen across
• 02:00the different ethnic and racial groups.
• 02:03So the talk has three main areas and
• 02:05I will briefly discuss some of the
• 02:08epidemiological data that we have.
• 02:10Then I'm going to talk about some of
• 02:12the environmental factors and then
• 02:14the molecular aspects and then putting
• 02:15that together trying to understand,
• 02:17you know.
• 02:18How much do we know of the reasons
• 02:21behind these academic that we're
• 02:24seeing across different groups,
• 02:26including the Hispanics?
• 02:27So this chart comes from the
• 02:30national databases where you can
• 02:33see that by the year 2050, right?
• 02:35You can see where the places where you're
• 02:38going to have larger groups of Hispanics,
• 02:40and you know colorectal cancer.
• 02:42It's one of those answers that
• 02:44continue to increase this.
• 02:45Find the available at screening
• 02:48methods that we have.
• 02:50And when you look at,
• 02:51you know the world right in the in
• 02:54the US we see that many Hispanic U.S.
• 02:58citizens have this high burden of this.
• 03:01So is the second most common
• 03:03cause of cancer among US Latinos.
• 03:05You can see the number there,
• 03:07the third most common cause
• 03:09of cancer worldwide.
• 03:11And then the fourth most common
• 03:14cause of cancer related death.
• 03:16So clearly this is a disease
• 03:18that continues to.
• 03:20You know to to take the life of
• 03:22so many people every single year.
• 03:24And here I described right where we
• 03:26go from the public to the cancer and
• 03:28this takes close to 10 to 15 years for
• 03:31people without having to re cancer.
• 03:33And when you put this into perspective right?
• 03:36And this is,
• 03:37I'm thinking about Latinos in America.
• 03:39You see that depending where you are,
• 03:42the burden of colorectal cancer
• 03:44changes dramatically.
• 03:45So if you look at,
• 03:46you know I put some arrows in order
• 03:48why at him? Tina and Puerto Rico.
• 03:50You can see the differences in
• 03:52incidence and mortality both
• 03:53for male and and female,
• 03:55and you know places like autowire,
• 03:57jentina, and Puerto Rico.
• 03:58We have things in common.
• 04:00Not only do we speak the same language,
• 04:01but with different accents, right?
• 04:03For those of people that know the
• 04:06different Hispanic communities.
• 04:08But we also eat a lot of meat, right?
• 04:10So that that's one of those factors
• 04:12that might come into play or might
• 04:14be contributing at this point and
• 04:16then looking at the data from the US.
• 04:18This is actually age adjusted.
• 04:20Incidence rates are in
• 04:22colorectal cancer in the US.
• 04:24Looking at the different races and
• 04:26Hispanic communities so you can see that
• 04:29the bias burden for both male and female,
• 04:31it's in the black community.
• 04:33However,
• 04:33when you look at what American Hispanics,
• 04:35it's very closed to when you
• 04:37combine all the races and is.
• 04:39I'm close to.
• 04:42I Landers, or are Native Americans, right?
• 04:46So you can see how.
• 04:48Even within the Hispanic communities,
• 04:50there are differences depending
• 04:51where the Hispanic is coming from,
• 04:54so it's not the same thing as when
• 04:56you look at Hispanics that are are
• 04:58from Mexico versus those that are
• 05:00from the Caribbean and you can
• 05:02hypothesize many of the reasons
• 05:03why we're seeing those differences.
• 05:05So this article was is,
• 05:07or over 10 years old.
• 05:08But I still look at this because
• 05:10it was mesmerized actually met
• 05:12Doctor Pinheiro in a presentation.
• 05:14And basically you know when
• 05:16they were looking at,
• 05:17he was evaluating the incidents.
• 05:19Rate for cancer and he looked at
• 05:22different groups and he looked at the
• 05:24incidence rate of cancer in their
• 05:26native community and then when they
• 05:28move to the US and this is data from Florida.
• 05:31So you can see that you know Mexicans
• 05:34and Mexico had a lower incidence rate
• 05:36as compared to Mexicans that move to the US.
• 05:39The same thing happened for Puerto Rican's.
• 05:41You can see how they you know
• 05:43when they are native Puerto
• 05:45Ricans living in Puerto Rico.
• 05:47The incidence is slower but
• 05:48when they move to the US this.
• 05:50Number goes up the same thing for
• 05:52Givens and look at how very close to
• 05:55their incidents for incidence rate for
• 05:57those that are native from Florida,
• 06:00so you know it's impossible to
• 06:02have this huge change based on the
• 06:05on the genetic changes, right?
• 06:07So so of course,
• 06:08environment is what really comes
• 06:10over and over into place.
• 06:12So I started working with several
• 06:15groups from the US including an
• 06:18Doctor Mariana Stern from University
• 06:21of Southern California.
• 06:22Anne Marie Anna published this article.
• 06:25A few years ago where she look
• 06:27at the disparities in colorectal
• 06:28cancer incidence among Latinos.
• 06:30But California is a melting pot.
• 06:32Don't know, right?
• 06:33So we have Latinas from South America,
• 06:35Central America and of course
• 06:37also from the Caribbean.
• 06:38So she was able to identify that 17% of
• 06:42all Latinas from California presented
• 06:44with colorectal cancer before the age of 50.
• 06:47So early on set colorectal cancer
• 06:49and this was published before the
• 06:51recent guidelines,
• 06:52right where?
• 06:53Now we start performing colorectal cancer
• 06:55screening at the age of 45 according
• 06:58to the US Preventive Services Task Force.
• 07:00So this is before,
• 07:01you know,
• 07:02five years before that happened
• 07:04and you know she had a good
• 07:06representation from Puerto Rican's
• 07:07and also Mexican Americans.
• 07:09And then of course the other you
• 07:12know worrisome factor was at
• 07:1449% of Latinos presented with
• 07:16colorectal cancer and advanced age.
• 07:18So not only younger,
• 07:19but also an advanced age.
• 07:21And this is data from our group.
• 07:23When they presented with early
• 07:25onset colorectal cancer,
• 07:27this survival is is less.
• 07:29So now let's let's chip gears
• 07:30and talk a little bit about.
• 07:32You know some of the environmental factors
• 07:34that we and others have been evaluating so.
• 07:37Things like tobacco are fabulous
• 07:39diet right which sometimes can
• 07:41not be as good as it could.
• 07:43It could be obesity, which is, you know,
• 07:46a common risk factor for many diseases,
• 07:48including cancer and of course is
• 07:50sedentary lifestyle an you know.
• 07:52Looking at the different aspects
• 07:54right a few years ago in 2015 The
• 07:58Who for the first time you know
• 08:01classified red and processed meat as
• 08:04part of the carcinogenic risk factor.
• 08:07So specifically.
• 08:08Processed red meat was classified
• 08:11as a carcinogenic class one,
• 08:13and to put everyone into context,
• 08:15this is the same category where you have H.
• 08:16Pylori where you have asbestos where we
• 08:20have other other factors like tobacco,
• 08:23so they're all carcinogens.
• 08:25Class one,
• 08:26but the risk associated to exposure of
• 08:29this particular environmental factor.
• 08:32It's much less that that you know
• 08:34that observed in other risk factors
• 08:36such as asbestos, for instance.
• 08:39Nonetheless,
• 08:39you know this started as supported
• 08:42on the role between the exposure
• 08:44of these carcinogens because they,
• 08:46you know we know now know that there
• 08:48are changes that occur at the level of
• 08:51the DNA where you get a heterocyclic
• 08:53amines and you know changes that
• 08:55increase carcinogenesis at the level
• 08:57of the colon and in the colony sites.
• 09:00So few years later there were also articles
• 09:03that started to put together the role
• 09:06of the diet with the role of the microbiome,
• 09:09right?
• 09:09And we've seen.
• 09:11This on our group have also evaluated
• 09:13the potential link between the
• 09:16MICROBIUM and the cancer risk,
• 09:18so this article was one of the few first
• 09:22rather articles that started to look at
• 09:25the role of the microbiome and cancer,
• 09:28and this beautiful paper by the group
• 09:31at Pittsburgh presented data looking
• 09:34at the different they phylogenic
• 09:36differences in the gut microbiome
• 09:39between Africans from Africa.
• 09:41That's on the left panel and
• 09:43Africans from North America.
• 09:44So you know the classic African U.S.
• 09:48citizens so you can see that even
• 09:51if we don't know that much about,
• 09:53you know these statistics, right?
• 09:55You can see that the colors right of
• 09:58these beautiful figures were different,
• 10:00right?
• 10:00So the Africans from Africa have it?
• 10:03How distinct microbiota as compared
• 10:06to the North American Africans?
• 10:09Right there African Americans rather.
• 10:11So and then you know when you look
• 10:14further down and he did and you look
• 10:16at you know what type of metabol I'm
• 10:19a metabolomics was present in the God
• 10:22from people that were in Africa and
• 10:25those North American African Americans.
• 10:28Not only was where the bacteria
• 10:30different but also the mandible.
• 10:32You know the type of metabolomics
• 10:34that that were present.
• 10:36So for instance he looked.
• 10:37He looked at short chain fatty
• 10:39acids and he looked also in bile
• 10:41acid and you can see that.
• 10:42Africans had a higher good short
• 10:45chain fatty acids versus the African
• 10:48Americans had more carcinogenic bile
• 10:51acid and you can see how the different
• 10:54compounds that he look at where
• 10:57higher Lee were present at a higher
• 11:00prevalence among individuals that had
• 11:03the microbiome was a distinct microbium.
• 11:05So we started looking.
• 11:07You know,
• 11:08of course, motivated by this group of
• 11:12investigators at Pittsburgh and some others.
• 11:14We started to evaluate not only the
• 11:17bacteria nor the microbiome composition,
• 11:19but also the jeans that are
• 11:22present because depending on the
• 11:24Organism that it's in the bowel,
• 11:26the jeans that are produced and the
• 11:28answer the proteins that are produced
• 11:29by the jeans and the specific genes
• 11:31that we can find that are bacterial
• 11:33genes may also modify the risk of having
• 11:36inflammation and the risk of cancer.
• 11:39So we started looking at this particular
• 11:41group of genes which are bacterial.
• 11:44Jeans specifically PKS,
• 11:47CTD and jealous,
• 11:50and eyes Ian such toxic necrosis factor
• 11:54necrotizing factor rather an USB,
• 11:56and you can see here is summary of what is
• 11:59the role of this particular bacterial genes,
• 12:02and our hypothesis was that in patients
• 12:05that have colorectal cancer had had
• 12:07colorectal cancer or those with polyps.
• 12:10We may see a difference not only
• 12:11in the bacterial composition,
• 12:13but also in the bacterial genes.
• 12:16And we set ourselves to do
• 12:18a series of experiments,
• 12:19and we published recently an you
• 12:22know from this group of of bacterial
• 12:24genes we were able to start to
• 12:27see some differences right?
• 12:29So I can show you here the USP was we saw,
• 12:33you know a small signal.
• 12:35We are repeating this sample and
• 12:38adding additional bacterial genes
• 12:40to try to understand whether or
• 12:42not you know is it bacterial.
• 12:45You know the the microbiome per say.
• 12:47Or it is are those bacterial genes,
• 12:49the ones that are really increasing the risk?
• 12:52So there's a lot more that
• 12:54is happening in this arena.
• 12:56But you know,
• 12:57I'm a physician scientist and you know
• 12:59you always have to think about you.
• 13:01Know if we can modify certain things
• 13:03like you know what we eat and if we're
• 13:06able to show that a particular dysbiosis
• 13:09in your God is associated with you.
• 13:12Know with the inflammation
• 13:13and changes in the genome,
• 13:16then you know we'll work on that.
• 13:17But there are things that are like low,
• 13:19you know,
• 13:20low hanging fruits and you know access to
• 13:22healthcare which we all know that it has.
• 13:24If it's you know,
• 13:26huge impact in this part is that
• 13:28we have been observing,
• 13:29including disparities,
• 13:30that we see in colorectal cancer.
• 13:33I said it help collaborating with them
• 13:37several investigators at the University
• 13:39of Puerto Rico that were focusing
• 13:41on delays in access to healthcare.
• 13:43So basically there are three main
• 13:45belays that that could occur that could.
• 13:47Interfere with the outcome of a patient,
• 13:51so you have what's called primary delay.
• 13:53Secondary Lillian tertiary deley so
• 13:55primary deley is from this the time
• 13:58that the patient has a symptom to
• 14:00the first contact with the primary
• 14:03care physician.
• 14:04Secondary dilay is from the first
• 14:06contact with that primary care
• 14:08physician to a confirmed diagnosis
• 14:10and then the third chair is.
• 14:12Delay is the time from their confirm
• 14:15diagnosis to the start of treatment
• 14:17an disparities in any of these
• 14:19areas right between one group of
• 14:21patients and another group of patients,
• 14:23or or across segments of the population
• 14:26like rural versus urban or people
• 14:29you know with Medicaid versus those
• 14:31that are on commercial insurance.
• 14:34Will result in differences in outcomes,
• 14:36and in fact that was the hypothesis
• 14:39ANAN we we examined my patients with
• 14:42colorectal cancer and this was published
• 14:44a few years ago where we saw in this
• 14:47graph we were looking at relative
• 14:49survival 1/3 and five years of colorectal
• 14:52cancer among Hispanics from Puerto Rico.
• 14:55An in orange you can see in the
• 14:57top line you can see the relative
• 15:00survival among individuals that were
• 15:02on a private insurance an.
• 15:04On the Gray or the second line you
• 15:06can see their relative survival
• 15:08for individuals that diagnosed with
• 15:10colorectal cancer at different,
• 15:12you know time points and you can
• 15:14see that at 1/3 and also five years,
• 15:17this survival associated, you know,
• 15:20seen and observed among people that
• 15:22had the public insurance was lower as
• 15:24compared to the private insurance,
• 15:26and this was adjusted for buy as many
• 15:29factors as we could possibly adjust for.
• 15:32But of course lifetime exposure.
• 15:34Right to die it to the place that you
• 15:36were raised to the community that you leave.
• 15:39We cannot account for that,
• 15:41so you know there might be things
• 15:43that occur much before we're able
• 15:45to classify patients according to
• 15:46the health insurance that we can
• 15:48actually not measure.
• 15:49That is beyond their the.
• 15:53Environmental variables we couldn't.
• 15:55We can't control for,
• 15:57so I want to finalize.
• 15:59You know, I now focus on an area that
• 16:01is extremely important, which is.
• 16:04Can we modify the genes?
• 16:06Can we blame the genes right?
• 16:07And when you think about Hispanics,
• 16:10Hispanics, we are a group of
• 16:12individuals that are a mix race.
• 16:14Hispanics have a mixture on depending
• 16:17where you find the Latinos in
• 16:19the US or or in Latin America.
• 16:21The composition of our genes
• 16:23berries dramatically.
• 16:24So if you go to places like in the Caribbean,
• 16:2720% of our genes are from African ancestry
• 16:30and in fact I did genomic ancestry and
• 16:32I have 14 and you know if you go to.
• 16:35South America there places that
• 16:36most of the genes are Europeans,
• 16:38but there are places where there
• 16:40is a significant percentage of the
• 16:42genes that come from Amerindian,
• 16:44so places like in Central America and
• 16:46and some areas in South America as well.
• 16:49So when the TSJ it started,
• 16:53you know years back now and
• 16:55this was published years ago.
• 16:57Yeah, as part of the Cancer Genome Atlas,
• 16:59one of the questions that we
• 17:01had and we had hoped for,
• 17:03was that when this samples
• 17:04the tumor samples were.
• 17:06We're going to be analyzed that there
• 17:08would be good representation from
• 17:10different racial and ethnic groups,
• 17:12and we all know now that that's not the case.
• 17:15So this is basically for colorectal cancer.
• 17:18There was no data on Hispanics from
• 17:21you know that were included when
• 17:24they evaluated colorectal cancer,
• 17:25but you know, overall we learned that
• 17:2816% of the tumors were hyper mutated and
• 17:31and there was no molecular difference
• 17:33when we look at rectal cancer rectal.
• 17:36You know cancer in direct
• 17:38numbers is cancer in the colon.
• 17:39And of course you know later on papers
• 17:43were published where you know we saw the,
• 17:45you know the differences in the
• 17:48percentage of tumors that came
• 17:50from individuals from minorities.
• 17:52Both racial an Hispanic minority.
• 17:54So of course, you know we need
• 17:56to continue to collect my data.
• 17:58There's a lot of great efforts that
• 18:00I applaud many of the institutions
• 18:02and including the NIH, NCI,
• 18:04and some other, you know,
• 18:06large populations like the.
• 18:08Breaking Cancer Society a CRM,
• 18:10others that have now started
• 18:12funding like that,
• 18:13you know as part of the up the effort to
• 18:15try to understand tumors from minorities,
• 18:18some including the Genie project
• 18:20that I'm sure that you guys are
• 18:23also information are involved with.
• 18:25So this was a publication we've had
• 18:28a few years ago doing a whole genome
• 18:32sequencing for patients with colorectal
• 18:34cancer data from the Puerto Rican
• 18:36Hispanic was included in this server.
• 18:38A fifth of all.
• 18:39Hispanics were from Puerto Rico
• 18:41and you can see that we were able
• 18:43to replicate some of the GI.
• 18:45You know the slaves that were
• 18:47seen in non Hispanic groups,
• 18:49but there were some that were only
• 18:50pressing in or his family community.
• 18:52So again there are some differences
• 18:54that may might be drivers of this is,
• 18:57but there's still a lot to do.
• 19:00We started evaluating this
• 19:02somatic that was German profile.
• 19:04We also started violating this
• 19:07melodic profile of Latinos
• 19:08with colorectal cancer and.
• 19:10This is the first publication we
• 19:12had years back and now I have.
• 19:14We have more recent data and I'm
• 19:16going to share with you and the first
• 19:18thing we notice was that Puerto Rican
• 19:20Hispanic with colorectal cancer.
• 19:22Those tumors were not.
• 19:24No, we're not.
• 19:25You know, we're not similar in several.
• 19:28You know? Key biomolecular markers,
• 19:31like you know, microsatellite instability.
• 19:34Right now it is.
• 19:35We know that MSI is so important because
• 19:39it really defines a phenotype that
• 19:43responds beautifully to certain agents,
• 19:46right?
• 19:46Like immunotherapy.
• 19:47So in our regulation,
• 19:49we started seeing that our patients,
• 19:50you know,
• 19:51had very little microsatellite instability.
• 19:53And when you look at the.
• 19:55CPG Island Middle Asian phenotype was also,
• 19:58you know,
• 19:59lower as compared to non Hispanic
• 20:02whites and also are African American.
• 20:05So are tumors were little bit
• 20:07different so we decided in the last
• 20:10three years we decided to replicate
• 20:12this effort and now with the
• 20:15availability of commercial testing an
• 20:17in several organizations that have
• 20:20this information publicly available,
• 20:22we conducted a an analysis that
• 20:24was just probably not published.
• 20:26Was just a presented at the
• 20:29ACR annual meeting.
• 20:30Trying to have better understanding a
• 20:33better grasp of those actionable somatic
• 20:35mutations that are key now of what we
• 20:39all calls precision oncology right?
• 20:42When you think about large institutions,
• 20:45not minorities serving institutions,
• 20:47but those that serve other.
• 20:49You know non minority communities
• 20:51access to precision oncology within
• 20:54the framework of patient care.
• 20:56It's routine.
• 20:56However, when you look at,
• 20:58you know smaller centers community.
• 21:01Hospitals or even you know,
• 21:03minorities every institution.
• 21:04If this is something that
• 21:06it's starting to occur,
• 21:07and thanks to the technology that now
• 21:10has become more financially accessible,
• 21:13we're now being able to incorporate this,
• 21:15you know. River care for patients?
• 21:18Then why is this important?
• 21:20Because there are molecularly
• 21:21targeted therapies that we have
• 21:23seen that not only in GI cancer,
• 21:24but you know in non squamous
• 21:27cell lung cancer.
• 21:28And I'm just showing you some of the
• 21:30key articles that actually change the
• 21:32way that we practice medicine nowadays.
• 21:35So like just zoom up for her two
• 21:37positive and you can see right?
• 21:39Of course for the BRAF mutated Melanoma,
• 21:42which now we've seen some other tumors.
• 21:44So it's key because the.
• 21:47Pharmacol from the pharmacogenomics
• 21:50are being studied,
• 21:53but are almost like a secondary.
• 21:55It doesn't start with the pharmacogenomics,
• 21:58it starts with the farmac
• 22:01pharmacodynamics of one group,
• 22:02so this is key.
• 22:04Because if we don't know how prevalent
• 22:06are those biomarkers where we have?
• 22:10Therapies that we can use.
• 22:11Then you know our patients
• 22:13will never benefit.
• 22:14So the first thing that we have to
• 22:16do is to try to understand and we
• 22:18actually were able to do a this.
• 22:20This analysis which I just alluded to
• 22:23and that was burned there is here and
• 22:26we evaluated close to 1929 hundred
• 22:28thirty one individuals and you can
• 22:30see here the distribution of the tumors,
• 22:33and you know,
• 22:34we we look at, you know,
• 22:36the how many most of you know 60% male,
• 22:38I mean female and you can see the.
• 22:40Age distribution for the
• 22:42people that we evaluated.
• 22:43We used commercially available testing
• 22:45and we did it in collaboration with
• 22:47the Precision Oncology Alliance and
• 22:49we look at actionable mutations
• 22:52specifically for colorectal cancer,
• 22:54and you can see you know if you
• 22:56look at your patient population.
• 22:58We saw, you know,
• 23:00find different prevalence of some
• 23:02of the key oncogenes and some
• 23:04of the key markers.
• 23:06So for instance,
• 23:07video one was only present
• 23:08in 1% of our patients MSI.
• 23:11In 2%, which is much less than other groups,
• 23:14you can see how Keras,
• 23:16which entered be rough,
• 23:19was also highly prevalent.
• 23:22So what we did was that we compare
• 23:24our data from patients data that
• 23:27was available for non Hispanic
• 23:29colorectal cancer tumors that
• 23:31were reported as part of the PGA.
• 23:33And here you can see the actionable genes.
• 23:36Queiroz be rough interests or
• 23:39her to Intrax Ann.
• 23:41You can see in green we have the
• 23:44Puerto Rican Hispanics and in
• 23:47blue we have the non Hispanic
• 23:49tumors from the TSJ and for some
• 23:52of the key oncogenes like Keras,
• 23:55ambera you can see that Hispanics
• 23:57from Puerto Rico who are more
• 24:00likely to present with mutations in
• 24:02this particular oncogenes.
• 24:04And that's terrible because then we
• 24:06have less access to some of the you know
• 24:10antibodies against EGFR for instance.
• 24:12This same thing, you know lack of certain
• 24:16biomarkers like PDL one or or Ms one.
• 24:19Among you know, this Hispanic
• 24:22community really also affects right?
• 24:24The availability of therapies to finalize.
• 24:28I want to very briefly show you some of
• 24:32the data that we have been working again
• 24:35with a group of collaborators, actions,
• 24:37collaborators from different places,
• 24:40including them rikidozan.
• 24:42Garner
• 24:45from inside and now he's in New York,
• 24:47so we actually look at African ancestry.
• 24:50Why? Because we know that African
• 24:53Americans have a higher risk
• 24:55of having colorectal cancer.
• 24:57They're having higher mortality as compared
• 24:59to other non African American groups,
• 25:02so we look at on the association
• 25:06between having African ancestry in
• 25:09Puerto Rican Hispanics and certain
• 25:12phenotypes and also molecular markers.
• 25:15In our patients with rectal cancer,
• 25:17so we were able to identify that individuals
• 25:21with African ancestry were more likely
• 25:24to have tumors located in thatis.com.
• 25:26So two times more likely than those
• 25:28Puerto Ricans without African ancestry.
• 25:30We also saw that the differentiation,
• 25:32they weren't the tumor from Puerto
• 25:35Rican's with higher African ancestry had
• 25:37a higher likelihood of having a low to
• 25:40moderate tumor difference differentiation.
• 25:43And you know,
• 25:45this might also contribute to the.
• 25:48Observe increased mortality that
• 25:50we observe in our population.
• 25:52So to finalize and there's many more data
• 25:55than we could discuss that may be asking
• 25:58the QA I want to keep everyone in mind.
• 26:01Keep everyone in mind that still the
• 26:03number one tool that we have available
• 26:06for you know the Christmas parties
• 26:08is doing colorectal cancer screening.
• 26:11Having access to die early diagnosis and
• 26:14you know still to this day there still.
• 26:18Differences in the optic of
• 26:21colorectal cancer screening.
• 26:23When you look at the different minorities
• 26:25and racial groups and the same thing
• 26:27we see in Puerto Rican Hispanics and
• 26:29also you can see it in the US Hispanics
• 26:31and because of the burden of disease
• 26:33where we had 10% of our patients with
• 26:36colorectal cancer in Puerto Rico,
• 26:37were part of being diagnosed with
• 26:40colorectal cancer before the age of 50.
• 26:43We move with the Department of Health,
• 26:45and in 2015 we.
• 26:47Put together an administrative order to start
• 26:50screening for colorectal cancer with feet.
• 26:53So we have a national feed program
• 26:56for people without family history to
• 26:58start performing fit testing at age 40,
• 27:01we were able to increase our rates to 65%,
• 27:05which was the highest and that was
• 27:07just before the Big Hurricane and
• 27:09then copied came to Puerto Rico.
• 27:11So now we have where's have started again,
• 27:13you know,
• 27:14to continue to promote screening.
• 27:17So in summary.
• 27:18We've been able to briefly discuss some
• 27:20of the Asian associated disparities,
• 27:23writing incidents and survival for
• 27:25correct cancer among US Hispanics.
• 27:27We have shown differences not only
• 27:30between non Hispanics and Hispanics,
• 27:32but also across the different
• 27:35Hispanic subpopulations.
• 27:36We discuss some of the differences are
• 27:40at the molecular level that include key,
• 27:44actionable biomarkers that are not present
• 27:46or present depending on the biomarker.
• 27:49Among Hispanics compared to non Hispanic
• 27:51and you know how non European ancestry,
• 27:54at least in the Caribbean,
• 27:55Hispanics from Puerto Rico was
• 27:57associated with worse colorectal
• 27:59cancer outcomes and nutrition,
• 28:01which you know when you think
• 28:03about the disease,
• 28:04is front and center might mediate
• 28:08the microbiome dysbiosis and it.
• 28:11You know we might be able to modify some of
• 28:14those risk factors.
• 28:16This is the team that I work with
• 28:18and this was this past March.
• 28:19For the correct awareness dressed in
• 28:22blue and I would like to finalize by
• 28:25thinking about the National Cancer
• 28:28Institute and the NIGMS as well as
• 28:31local fan from Puerto Rico government.
• 28:35For some of the work that you have seen,
• 28:37ankle appears from multiple places
• 28:39including the friend of mine, Doctor,
• 28:41Shabbir Yard and hopefully maybe he's
• 28:44in the call and some other great friends
• 28:48across different centers in the US.
• 28:50For what we do, thank you very much.
• 28:52I think I was trying to make
• 28:54the time 10 minutes. Let's see.
• 28:57This is part of our campaign
• 28:59that we have for.
• 29:00We call it the other cleavage
• 29:03so our people to stop,
• 29:04you know,
• 29:05to think about the colon and do
• 29:07colorectal cancer screening.
• 29:11Can you hear me again?
• 29:13OK, good good good thank you so much.
• 29:17You are efficient and I was trying to.
• 29:20I'm sorry no that's so great.
• 29:23So I am going to Roy.
• 29:26I might let you ask a question first
• 29:28if you're willing while I pull up.
• 29:30Your Cam has a massive thanks.
• 29:32So much for being here.
• 29:33How are you Roy?
• 29:36Let me ask you a question.
• 29:37It's something related so you know
• 29:38I'm working very closely with
• 29:39the Clinical Trials Office here
• 29:40and I notice that our accrual.
• 29:42Of Latin Hispanic patients is really poor,
• 29:45and that's something throughout
• 29:47the United States.
• 29:48Any any tips on how we can improve that?
• 29:50I know it's a general problem. Yeah,
• 29:52it's a general problem there.
• 29:53There's a lot of distrust, right?
• 29:55And and I think still,
• 29:57there's a huge Guinea pig concept,
• 30:00so you know one of the things that
• 30:02we have done, locali, you know.
• 30:03And remember, I'm a Puerto Rican
• 30:05working with Puerto Rican's, right?
• 30:06So so people shouldn't be discriminated or
• 30:09feel discriminated because of the you know,
• 30:10rate, racial and ethnic concordance.
• 30:13But one of the concepts that we
• 30:15have started to use is that I don't
• 30:17like to use the word investigation,
• 30:20which means research,
• 30:21because when you put the word
• 30:24investigation or research,
• 30:25or you know people immediately, they stop so.
• 30:28So the word that we're using now.
• 30:29We used protocols, you know,
• 30:32National Cancer Institute protocol
• 30:34or industry treatment protocols.
• 30:37And then we explained to them what it means.
• 30:40Of course,
• 30:40this is before the FDA approves the drug,
• 30:43so I tell them that.
• 30:44But it's almost like it's at
• 30:46least this is what I see.
• 30:47You know, when you use the word research,
• 30:50most people simply become scared,
• 30:52so you need to have cultural competency
• 30:55an you know as much as we can have,
• 30:58you know someone to speak to
• 31:00them in the remaining language.
• 31:01And if you can do that concordance,
• 31:03it increases your chances
• 31:05you know dramatically.
• 31:08During navigators now, and we're
• 31:09translating all the consent forms.
• 31:11Salute Lee, you know Roy.
• 31:13Even there be a you know.
• 31:15I wish everyone would
• 31:16imagine that they will have.
• 31:18You know, multiple language
• 31:19consent forms they do not sovyet
• 31:22trials which I have, you know,
• 31:24and I I was adamant about the fact
• 31:26that you know they had to have any
• 31:28more than one language because you
• 31:29know we have people that are U.S.
• 31:31citizens that speak another language.
• 31:33So I said we better than you
• 31:35know and it's it's working.
• 31:36So yeah black,
• 31:37I congratulate you.
• 31:39For for doing that
• 31:40where we're trying now,
• 31:41listen before we go on.
• 31:42Cam has a little presentation for you.
• 31:46I mentioned in the beginning that
• 31:49Russia is our our inaugural inaugural
• 31:52recipient of this annual Lectureship Plex,
• 31:56so we will be sending this to you.
• 31:58We wish it were interested,
• 32:00but we're we're really grateful for
• 32:02your presentation and presence today,
• 32:04so thank you so much for joining us. Thank
• 32:07you, thank you very much.
• 32:08It's an honor, and you know.
• 32:18I'm trying to pull all these things together.
• 32:20It's it's, you know,
• 32:21he's really a Humira Chal sometimes.
• 32:24And you know and we need to work as teams,
• 32:26so I'm glad that you are. You know,
• 32:29doing this for thank you. Thank you.
• 32:30Yes, now we would.
• 32:31We would love to do that, you know.
• 32:33And I think that one thing
• 32:35just to highlight for you.
• 32:36And I think for potential
• 32:38future conversations and
• 32:39collaborations are are greater.
• 32:41New Haven community is very diverse
• 32:43and I think we have a lot of
• 32:46you know Hispanic patients and.
• 32:48My patients and I think,
• 32:50as I'm sure you know,
• 32:51this three year work with doctor
• 32:53your were eager to make sure that
• 32:55we're meeting the needs of these
• 32:57patients in our catchment area.
• 32:58And I think I was really,
• 33:01I think I really liked your work on
• 33:03the microbiome versus bacterial genes,
• 33:05and I think really trying
• 33:07to do a deeper dive,
• 33:09both in terms of that but also
• 33:11precision medicine to really meet the
• 33:13needs of a more diverse population.
• 33:15That's correct, that's correct,
• 33:16and you know, it's almost like impossible.
• 33:18You know to try to answer every question,
• 33:21so the way that we have you know our
• 33:23approach has been to really collaborate
• 33:25with teams and you know from basic
• 33:28scientists and you know to physician
• 33:30scientists and even the Community, you
• 33:32know that that work that I show you about.
• 33:34You know access to care.
• 33:35I mean, I, I, I was really amazing.
• 33:38I love the molecules and you
• 33:40know when you talk about jeans,
• 33:41I get very excited but but
• 33:42then I realize that, you know,
• 33:44we have to also tackle the community.
• 33:46The access to health care.
• 33:49It doesn't explain all.
• 33:50OK, because you sweesy populations
• 33:52any this has been published many
• 33:54times over that with the same
• 33:56access to care you see differences
• 33:58right using these disparities.
• 34:00But you know some of the key
• 34:02factors may be mediated to you,
• 34:04know those genes that we inherit,
• 34:06and there was a an article published
• 34:08maybe three months ago by the group that
• 34:10blanket and it was published in Nature.
• 34:12He was about.
• 34:14Lung cancer an ancestry and you
• 34:16know it was beautifully presented
• 34:19that depending on your ancestry,
• 34:21particular genes that were driver for
• 34:24lung cancer were present, so you know.
• 34:26Of course,
• 34:27if you are exposed to more carcinogens right,
• 34:30you will have a higher risk
• 34:31for developing cancer,
• 34:32but it was not explained by the
• 34:35environment was explained by the genes.
• 34:37So this same approach we need to dive deeper.
• 34:40And now you know,
• 34:41identify you know what are
• 34:43those other you know.
• 34:44Genes that might be related to inflammation,
• 34:47you know, stress related and not really.
• 34:49You know, you know Uncle genes,
• 34:52but maybe just stress related right?
• 34:54And you get more of you know like
• 34:56for instance we've been looking into
• 34:58interleukins and whether or not
• 35:00having a particular Geno type in key
• 35:02interleukins that are inflammatory
• 35:04mediated my increase the risk of
• 35:07developing cancer once you you
• 35:09know expose that to two whatever
• 35:12carcinogen and we're doing that.
• 35:14Usina organoid models.
• 35:15It's not my.
• 35:16My work is part of the team,
• 35:18so you know there are many more
• 35:20questions that we could try to attend by
• 35:23really dissecting all the different areas.
• 35:28That's great, I don't see any
• 35:29other questions in the chat,
• 35:31but please post them if you have any,
• 35:33and I'll maybe ask.
• 35:34Ask another one or just a comment
• 35:37you know I did not know that the
• 35:39TGA had really like such little
• 35:42diversity and zero Hispanics,
• 35:44and I think that I'm wondering
• 35:46as you can in your sort of
• 35:48leadership roles in the survey,
• 35:50CR and other organizations.
• 35:52What are some ways that you
• 35:55are going to propose basic and
• 35:58translational researchers?
• 35:59To conduct more diverse research,
• 36:02yeah and and you know,
• 36:03thank God that this has started already,
• 36:06so you know they said,
• 36:07you know when when we were all like you know,
• 36:09looking at the data and you know seeing
• 36:12the the lack of diversity right at the
• 36:15same time a huge effort started on the ACR.
• 36:20Really, you know, promoted the genie,
• 36:22the project Genie right?
• 36:23Which now when you look at the
• 36:26centers that contribute to tumors.
• 36:29Much more diverse centers,
• 36:30and now we have close to
• 36:3310% in certain cancers.
• 36:34We have 1015% representation and
• 36:36then the same thing is happening
• 36:38with the prostate cancer right there.
• 36:40Large cohort of prostate cancer.
• 36:42Men that had our 2000 and it's it's
• 36:45halfway there in the collection
• 36:47and it's really focus on African
• 36:49Americans with prostate cancer.
• 36:51Because I mean,
• 36:52how can we understand and better serve our
• 36:55community of patients if we don't know?
• 36:58You know what is the molecular?
• 36:59Profile for these groups so I will know.
• 37:02I will tell you that the change has
• 37:05been dramatic and you know communities
• 37:07like the ACR and you know and even
• 37:10you know inside NCI because you
• 37:12would say why didn't we think about
• 37:14this right when we put it together?
• 37:15Well, there's something called subliminal.
• 37:18You know bias right?
• 37:19I mean some sometimes subconsciously
• 37:20messed up conscious.
• 37:22Sometimes you don't even think
• 37:23about it because there's nobody on
• 37:25the table to remind you, right?
• 37:27So you know when you look at
• 37:29institutions like you know the.
• 37:30NCI that represents,
• 37:32you know the whole USA America
• 37:35right 350 million,
• 37:36whichever number we are right,
• 37:38we need to have representation and
• 37:39you know when you look at the NCI.
• 37:41For instance,
• 37:42there are two important bodies like
• 37:45they they NCIB right in the baby.
• 37:49I forgot the whole nomenclature
• 37:50is one of the groups that advisory
• 37:53boards with the National Cancer
• 37:55Institute Advisory Board.
• 37:56And then we also have the Board
• 37:58of scientific advisors.
• 37:59So you know,
• 38:00those are the group of individuals
• 38:02that are scientists that represented
• 38:03different segments of our community of sign.
• 38:06That it's important that we start
• 38:08having representation from the top,
• 38:10because if we are not at the table right,
• 38:13you know you know what they idiom says.
• 38:15So I think that that's one of the
• 38:16things that has started to happen,
• 38:18and you know the same thing
• 38:20applies for women.
• 38:20And you know, I always have to,
• 38:22you know, remind people that you
• 38:24know 50% of us are they look like me,
• 38:27but sometimes when you look at the
• 38:29leadership,
• 38:29you only see 10% of us,
• 38:31so you know it's important to
• 38:34promote diversity.
• 38:36Across religion ethnicity,
• 38:37you know gender and you know race
• 38:40and I'm starting with leadership
• 38:42positions and when we are there
• 38:44you know then we make,
• 38:46you know we we make our point.
• 38:47We make sure that we know we're
• 38:49not oblivious to that.
• 38:50So I think you know the short
• 38:52answer is that we're doing better.
• 38:53We're going to have good data in the next few
• 38:55years and that data that I just showed you.
• 38:58I mean, that was commercial data,
• 39:00so we basically took RSR group
• 39:01of patients and you know,
• 39:03in 10 years before that would have been.
• 39:06Impossible for anyone to afford.
• 39:08You know, over $1000 that that
• 39:10cost about $3000 per patient.
• 39:12And you know that we're required
• 39:14a large or one to do it right?
• 39:16But now we can use those
• 39:18commercially available databases,
• 39:19which you know allows an investigator you
• 39:22know to start comparing and pulling data.
• 39:25You know DJ is only one of the databases.
• 39:27We have multiple lines.
• 39:29I mean, there are multiple lines that.
• 39:32Smart people can I get?
• 39:33You know people that you
• 39:34know have good questions,
• 39:36can pull an evaluate,
• 39:38so hopefully soon will have much more.
• 39:41Great, well we are just
• 39:43about at the hour or so.
• 39:45Thank you Doctor Cruz Correa
• 39:47for joining us today.
• 39:49Thank you for tonight.
• 39:50We're excited to continue the
• 39:52conversation with you and other forums.
• 39:54Roy any other words?
• 39:57It's wonderful to have you here
• 40:00and hopefully someday in person and
• 40:02looking forward to working with you,
• 40:04you've given us many things to think
• 40:06about that are really important
• 40:07for our community and for patients.
• 40:08And and thanks so much for your time.
• 40:11Thank
• 40:11you very much. We are really
• 40:13privileged group to be able to,
• 40:14you know, do something that we
• 40:16love and I think that's for me.
• 40:18That's the key and am I see
• 40:20that you guys are also,
• 40:22you know doing the same.
• 40:23So thank you for the invitation
• 40:24royal pleasure to see you again.
• 40:27We will be sending you that plaxo.
• 40:29OK, you're gonna love your office about
• 40:32be delighted to I'm right here so
• 40:35thank you. Thank everyone and
• 40:37goodbye. My friends are there
• 40:38as well. So happy to see
• 40:40you all bye bye thank you.