Research priorities of the CTPHG will be focused on studies to systematically assess multiple layers of information, including epidemiologic, genomic, and clinical data, across the continuum of cancer development and care to provide an integrative view of cancer development, prognosis, therapeutic response, and long-term survivorship and quality of life.
Genetic Susceptibility to Prognosis, Treatment Response and Adverse Events
Genome-wide association studies (GWAS) to identify novel genetic loci for clinical outcomes require a large patient population with well-documented tumor characteristics, treatment regimens, and follow-up data, necessitating strong interactions with the multiple SPOREs within the institution, and close collaborations with other institutions and national clinical research organizations (e.g., SWOG, ECOG, and RTOG). The CTPHG is in a unique position to take a lead in this area due to the large patient populations and clinical data through the MD Anderson Cancer Patient Cohort, the involvement of our clinical faculty in national organizations, and the leading programs in population sciences.
Risk Prediction Models for Cancer Development, Prognosis, Treatment & Toxicity Response
Individuals have differing risks of developing cancer based on their unique combinations of genetics, exposures, and behaviors. Understanding this risk can inform various risk reduction strategies to prevent cancer development and facilitate early detection of cancer when treatment is most successful. Furthermore, identification of high-risk individuals for cancer progression, recurrence, radiation toxicity, or development of second primaries following initial curative treatment may allow the development of targeted interventions to prevent or decrease the probability of such events. Risk prediction models that incorporate multiple layers of information (such as epidemiology, clinical variables, genetics, phenotypes, and molecular profiles) are an important tool in assessing individual risk at each stage of the cancer continuum.
An individual’s underlying genetic background may play a major role in determining response to preventive intervention. With the advances in genomics, it is now feasible to identify markers to identify candidates who should receive intervention and those who would not benefit. The CTPHG is well-equipped not only in technology platforms, but also in terms of expertise and knowledge to lead the effort in understanding the genetic and epidemiologic factors that influence response to interventions and create a model that will incorporate these variables to predict which intervention will be appropriate for each individual.
Public Health Genomics
Public health genomics assesses the impact of genes on the population’s health. There is a strong need to bridge the gap between genomics research and public health. Therefore, the CTPHG will work to identify and validate markers that can be used within a clinical and public health setting while also working closely with industry partners in developing the tools required for this process. This has been shown to be successful for breast cancer screening with the testing for BRCA1/2 mutations. Without dissemination at the population level, the impact on public health will be minimal.
The CTPHG will work closely with the Departments of Behavioral Science and Health Disparities Research to identify genetic and molecular markers for smoking cessation, tobacco use, obesity/energy balance, and other behaviors that contribute to cancer risk. There is a need to develop effective smoking prevention and cessation strategies with the potential to enhance these approaches through the incorporation of genomic information. Not only smoking behavior, but obesity, energy balance and dietary habits have also been shown to be significant factors modulating cancer risk. Inter-individual differences in genes that control pathways involved in these behaviors could provide clues as to why we see such dramatic differences across the population, and also identify potential interventions to reduce these behaviors – an area where the CTPHG can contribute significantly.
Survivorship and Quality of Life
With improvements in cancer treatment, the number of long-term cancer survivors is increasing. There is a strong need for a better appreciation of the modifiable and genetic factors that influence symptoms and quality of life to aid in better approaches towards the health care of these individuals. The CTPHG, through the MD Anderson Cancer Patient Cohort, will provide a rich resource for quality of life and cancer survivorship research. Investigators will be able to identify changes in lifestyle and behavior that may affect patients’ outcomes or quality of life and provide basis for intervention and behavior modification strategies.