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Last Updated: 09/10/21

Translational Research Center in Lung Cancer Disparities (TRACER)

Virginia Commonwealth University Massey Cancer Center

Principal Investigator(s):

Robert A. Winn, MD
Robert A. Winn, MD

Victoria L. Seewaldt, MD
Victoria L. Seewaldt, MD

Chanita Hughes Halbert, PhD
Chanita Hughes Halbert, PhD

Principal Investigator(s) Contact Information

Robert A. Winn, MD
Director, VCU Massey Cancer Center
Sr. Associate Dean for Cancer Innovation
Professor of Pulmonary Disease and Critical Care
Lipman Chair in Oncology
Virginia Commonwealth University
401 College Street, Box 980037
Richmond, VA 23298-0037
(804) 628-1897

Victoria L. Seewaldt, MD
Ruth Ziegler Chair in Population Sciences and Chair, Dept. of Population Sciences
Professor of Surgery
Associate Director for Cancer Control
City of Hope Comprehensive Cancer Center
1500 Duarte Road, Building 173 Population Science
Duarte, CA 91010
(626) 471-7321

Chanita Hughes Halbert, PhD
Vice Chair for Research and Professor
Dept. of Population and Public Health Sciences
Assoc. Dir. for Cancer Equity, Norris Comprehensive Cancer Center
University of Southern California
2001 North Soto Street
Los Angeles, CA 90032
(323) 442-1192


Lung cancer continues to be one of the leading causes of morbidity and mortality among racial/ethnic minorities and individuals from other medically underserved groups because of multilevel determinants that include molecular and genetic factors, exposure to psychosocial stress, and structural stressors in neighborhoods and communities. The Translational Research Center in Lung Cancer Disparities (TRACER) establishes a multi-regional consortium among three National Cancer Institute-designated cancer centers: Massey Cancer Center (MCC) at Virginia Commonwealth University (VCU), Hollings Cancer Center (HCC) at the Medical University of South Carolina (MUSC), and the City of Hope Comprehensive Cancer Center (CoH), to address racial disparities in lung cancer morbidity and mortality by developing more precise strategies for lung cancer prevention and early detection. The SPORE is composed of two initial research projects and a Developmental Research Program, providing the mechanism to solicit, develop, fund, and evaluate new research concepts. These projects will be supported by a Biospecimen/Pathology Core, a Community Engagement Core, and a Biostatistics and Bioinformatics Core, coordinated by an Administrative Core.

To accomplish the overarching goal and vision for TRACER the SPORE leadership and investigators will:

  1. Discover cancer-driving biological mechanisms leading to racial disparities in lung cancer morbidity and mortality and analyze these mechanisms within the context of individual, social, and environmental determinants of health;
  2. Translate research findings into novel prevention, diagnostic, and therapeutic interventions;
  3. Develop an integrated interinstitutional partnership that promotes transdisciplinary research and leverages the distinct capabilities at each partner site to successfully obtain a P50 Cancer Disparities SPORE; and
  4. Promote bi-directional communications between AA/Black communities and investigators regarding research priorities, the development of culturally appropriate strategies for community engagement and participation in research, and the dissemination of education and research outcomes.

The translational research and related training, patient and community engagement, and biospecimen collection activities in TRACER will focus explicitly on addressing racial disparities in lung cancer morbidity and mortality in order to fulfill a critical need to develop precision strategies for lung cancer prevention and early detection.

schematic of TRACER program

Project 1: Comparing Exposure to Environmental Stress and PRMT6 Expression as Lung Cancer Risk Factors in Black Men

Project Co-Leaders:
Patrick Nana-Sinkam, MD (Clinical)
Robert A. Winn, MD (Clinical)

Lung cancer (LCa) remains the leading cause of cancer mortality in the United States (U.S.) with a projected estimate of 228,820 new cases and 135,720 deaths from lung cancer in 2020. Nationally, non-Hispanic African American/Black (AA/Black) men have a disproportionately higher incidence and rate of death from lung cancer compared to their non-Hispanic White (White) male counterparts; however, no such lung cancer disparities exist between AA/Black and white women nationally. Notably the increased rates of lung cancer mortality seen in AA/Blacks relative to their white male counterparts appears to be independent of smoking duration, intensity, quit years, and socioeconomic status. These disparities are likely driven by a complex and poorly understood interaction between inequities in access care, segregation, upstream determinants of health, chronic exposure to community stress, tobacco exposure, and molecular oncogenic drivers.

We have identified protein arginine methylation as a potentially exciting novel lung cancer biomarker and potential drug target, protein arginine methyl transferases 6 (PRMT6). We have determined that 1) PRMT6 expression is increased in AA/Black men; 2) smoking stimulates PRMT6 expression; and 3) PRMT6 overexpression in an in vivo model drives lung tumor development. We hypothesize that the combined effects of community stress and smoking in AA/Black men may be contributing to the AA/Black male "Smoking Paradox" and that PRMT6 may serve as a suitable biomarker capturing these combined exposures with the potential benefit of enhancing early detection of lung cancer in AA/Black men. This project aims to measure the interaction between the "community-ome" and the molecular determinants of lung cancer to better define the risks among AA/Black men. Gaining a better understanding of PRMT6 and its role as a molecular biomarker is an important first step to establishing this innovative approach. As such, it has become clear that the addition of molecular biomarkers, e.g. PRMT6 among others, could potentially improve the effectiveness of LCa screening. The findings from the proposed studies are expected to not only make significant contributions to the basic understanding of lung cancer health disparities in AA/Black men, but also assist in developing novel biomarkers for early detection of LCa in AA/Black men.

Lung cancer incidence (2013-2017) and Mortality (2014-2018) per 100,000 population

Project 2: Biological Pathways in Stress Reactivity and Nicotine Addiction among African American/Black and White Smokers

Project Co-Leaders:
Chanita Hughes-Halbert, PhD (Basic)

Even though smoking cessation is the best preventive strategy for reducing lung cancer risk and addressing racial disparities in outcomes, many smokers are unwilling or unable to make a quit attempt, and among those who try to quit smoking, utilization of evidence-based treatment is poor, especially in racial minorities. Stress relief, and the avoidance of adverse psychological and physiological reactions, are among the primary reasons for smoking initiation, maintenance, and relapse in all populations; there is an established relationship between perceived stress and smoking behaviors from observational studies. However, stress responses have both psychological and physiological consequences that are important to smoking behaviors and cessation outcomes. Despite the significance of the HPA-axis pathway for both stress responses and nicotine addiction, racial differences in physiological stress responses have not been examined between African American/Black (AA/Black) and white smokers. Under the leadership of an expert transdisciplinary investigative team that is supported by critical cores and shared resources for community engagement, biospecimen collection, storage, and processing, and biostatistics and bioinformatics in the Translational Research Center in Lung Cancer Disparities (TRACER), Project 2 will be the first to examine racial differences in HPA-axis functioning between AA/Black and white male smokers to achieve the following specific aims:

Aim 1: Examine racial differences in acute physiological stress responses between AA/Black and white male smokers using a laboratory model. The association between acute physiological stress response and tobacco-related behaviors will also be evaluated.
Aim 2: Evaluate racial differences in daily cortisol patterns between AA/Black and white male smokers.
Aim 3: Identify factors that are important to acute and daily stress responses among AA/Black and white male smokers by examining acute and daily cortisol patterns based on exposure to chronic stressors.

The relationship between acute and daily cortisol patterns, nicotine metabolism, and nicotine dependence will also be explored among AA/Black and white male smokers

Together with contextualized data on acute and chronic stress responses based on SES, psychosocial, and structural factors, Project 2 will generate novel empirical data that can be leveraged into precision strategies for lung cancer prevention through smoking cessation and other intervention approaches.

stress paradigm

Administrative Core

Core Directors:
Robert A. Winn, MD (Leader)
Victoria Seewaldt, MD (Co-Leader)
Chanita Hughes-Halbert, PhD (Co-Leader)

The Administrative Core of this Cancer Disparities SPORE planning provides an essential framework for supporting the distinct features as well as the more routine administrative tasks associated with a large, multi-institution, multi-project, and multi- core planning grant. It serves as the Translational Research Center in Lung Cancer Disparities' management entity, designed to engage a diverse cross-section of investigators representing lung-cancer focused and cancer disparities researchers, healthcare providers, and community- based patient and public health stakeholders from three distinct geographic regions - Virginia, South Carolina, and California. The core will be led by a team of Multi-Principal Investigators (MPIs), along with the guidance of an Executive Steering Committee, a Multi-Institutional Internal Advisory Board, an External Advisory Board, and a Community Advisory Board. Together, the Multi-PIs will leverage their distinct and complementary research and leadership expertise to oversee the day-to-day operations of TRACER as well as the shared governance structure to ensure proper oversight and coordination. They will oversee, coordinate, and support all the activities for the proposed SPORE and provide the communication, integration, fiscal oversight, planning, evaluation, and other required administrative functions to ensure all activities are well organized, documented, and performed efficiently.

Biospecimen/Pathology Core

Core Directors:
Charles Clevenger, MD, PhD (Co-Leader)
Michael Idowu, MD, MPH (Co-Leader)
Loretta Erhunmwunsee, MD (Co-Leader)
John Pearce, PhD (Co-Leader)

The TRACER Biospecimen/Pathology Core (BPC) will collect biospecimens from racially diverse lung cancer patients and individuals at high risk for lung cancer in support of cancer disparities research as well as provide a central data repository that links each specimen with essential histopathologic, clinical, molecular and social determinants of health data. The BPC will enhance TRACER supported investigations by factoring in multilevel determinants of cancer risk and outcomes.

Community Engagement Core

Core Directors:
Vanessa L Sheppard, PhD (Leader)
Christopher Sistrunk, PhD (Co-Leader)
Gayenell S. Magwood, PhD (Co-Leader)

The Community Engagement Core (CE) incorporates tenets from an innovative Community-to-Bench framework to ensure the long-term impact of closing the gap in lung cancer disparities attributed to various factors that exist across the continuum from prevention to survivorship. Addressing these disparities requires a collaborative approach that integrates expertise of community residents and scientists. The overall goals of CE Core are to connect scientists and community stakeholders, translate and disseminate TRACER research findings, and co-develop innovative strategies to do this within the context of addressing lung cancer disparities.

Additionally, the Core, including community members, will educate investigators on how to employ community outreach and engagement (COE) into their research, and provide training for the Biospecimen/Pathology Core that focuses on recruiting underrepresented groups to provide biospecimens and aid with incorporating community engagement approaches, recruiting participants, and disseminating findings for the pilot research projects supported with the Developmental Research Program (DRP). Under the leadership of an experienced multidisciplinary team and in partnership with multiregional advisory boards, the CE Core will use evidence-based models of dissemination and implementation for the successful translation of research findings to effective interventions at the clinical and community level.

Biostatistics and Informatics Core

Core Directors:
Dipankar Bandyopadhyay PhD (Leader)
Russell Rockne, PhD (Co-Leader)

The overall objective of the Biostatistics and Bioinformatics Core (BBC) is to serve as the focal point from which the TRACER investigators and career development candidates can draw the much needed biostatistical, genomics, and biomedical informatics expertise needed for proper planning and execution of their research projects. These services include assisting in experimental design, study plan development, hypotheses refinement, database integration and access, data quality control, sample size requirements and power calculations, analysis of the statistical design, development of randomization and stratification procedures, interim analyses, analysis of completed results (which includes both biostatistical and genomics analyses), presentation of research findings, and scientific publication to disseminate new findings in the prevention and treatment of lung cancer.

Developmental Research Program

Program Directors:
Victoria Seewaldt, MD (Leader)
Vanessa L Sheppard, PhD (Co-Leader)

To ensure a focused pipeline of transdisciplinary research explorations into lung cancer disparities the Developmental Research Program (DRP) within this lung cancer disparities SPORE application aims to select and support highly promising and innovative pilot research projects to reduce health disparities in lung cancer. The TRACER MPI and DRP leadership have set clear priorities for the selection of pilot research projects. These priorities are (1) projects demonstrating exceptional translational science potential, (2) projects inclusive of vertical and horizontal collaborations between the 3 participating institutions, and (3) projects with maximum impact on the diverse communities serving—Virginia, South Carolina, and southern California. These pilot research projects may include basic research explorations using human samples, diagnostic or treatment clinical interventions in the form of clinical trials, or community-based prevention interventions. The ultimate goal of the DRP is to establish a pipeline of research focused on the multi-dimensional causes of lung cancer disparities within the diverse populations served by the partnering institutions and to develop the preliminary data to support competitive research projects.

Institutional SPORE Website