Breast cancer is a devastating disease, but even more so for the Black community. Black women in the U.S. are more likely to die from breast cancer than white women due to many complex factors. They are also underrepresented in clinical trials, which among many other things, test and evaluate the effectiveness and side effects of breast cancer treatments.
Black women are also more likely than white women to experience a toxic side effect from chemotherapy called taxane-induced peripheral neuropathy (TIPN), a debilitating and sometimes permanent condition that includes throbbing nerve pain and tingling or numbness in the hands and feet. TIPN can impact not only quality of life for people with breast cancer but also the amount of therapy they can receive, as doctors must lower their doses or stop treatment completely to alleviate symptoms. This can lead to worse outcomes for Black women compared to white women.
Through a Komen-funded study, Komen Scholar Bryan Schneider, M.D., is seeking a new approach to improve outcomes for Black patients with breast cancer who experience TIPN as a side effect from chemotherapy. Dr. Schneider is director of the Indiana University Health Precision Genomics Program and a professor of medicine and medical/molecular genetics at the IU Melvin and Bren Simon Comprehensive Cancer Center.
Unraveling Disparities Through Precision Medicine
Dr. Schneider’s interest in disparities research goes hand in hand with his passion for precision medicine – an innovative approach that has inspired his career path. “Precision medicine is really the concept of embracing the uniqueness of each of us to make outcomes better,” he says.
Dr. Schneider began exploring how a person’s unique genetic makeup can affect treatment outcomes and noticed that Black patients in his clinic were experiencing more side effects from treatment than other patients. “That made me passionate about trying to unravel this potential intersection of side effects with race and disparities,” Dr. Schneider says.
Through a previous Komen-funded study, he found that Black patients developed neuropathy more often than other patients and identified some inherited genetic variations that put Black patients at a higher risk. This research laid a foundation for the EAZ171 clinical trial, where Dr. Schneider and his team are currently working to predict which patients will be at highest risk for this side effect with a simple blood test and personalizing therapy to effectively treat breast cancer without causing TIPN.
“We feel that this trial is really set up to potentially change the standard of care for Black patients in the adjuvant setting, but we want to learn more, and this is really where our Komen-funded work is going to come into play,” he says.
Improving Patient Survival
Through his Komen project, “Translational approach to mitigating racial disparities in drug-induced toxicity,” Dr. Schneider will build on his recent work by seeking genetic causes and potential solutions to treat or prevent TIPN. His long-term goal is to decrease the disparity in survival rates for Black patients with breast cancer in the U.S. through personalized, tailored treatments.
For this project, Dr. Schneider will use patient blood samples to build miniature “nerves” in test tubes that can mimic a patient’s response to a treatment, including whether a drug causes neuropathy or nerve damage. By identifying the changes that take place at the gene level and understanding which chemotherapy drugs cause these changes, Dr. Schneider and his team hope to find treatments that are just as effective without causing harmful side effects. This may ultimately also give insight into the development of drugs designed to better treat or prevent neuropathy.
“Through precision medicine, if we’re able to understand who’s getting neuropathy and figure out ways to stop it from ever happening, I think we’ll be able to improve drug acceptance and start improving survival rates,” Dr. Schneider says.
Bringing More Inclusion to Research with Komen
A critical part of bridging the disparities gap in research is including members of underrepresented populations in clinical trials. A current study shows that in the U.S., patients of Black race make up approximately 15% of the population but only represent about 2% to 6% of clinical trial participants.
As Dr. Schneider observes, the key to successful participation in a clinical trial like EZ171 is working with community partners, including churches and other local organizations, to reach people in a meaningful way. “If you explain the goals of the research in a way that highlights why it is important and in a way that connects with the community, patients will come and participate,” he says.
Critical research projects funded by Komen, like Dr. Schneider’s work, are opening doors to exciting new possibilities for patients.
“We’re seeing advances happen right before our eyes. It’s all inspiring, and while we certainly still have major gaps – and we have a long way to go for a lot of our patients – it’s really exciting to see us getting better at this in real time.”