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Cancer prevention, treatment, and biology

TRDRP will support research into the causes, early detection, and effective treatment, care, prevention, and potential cures of cancers that the Report of the Surgeon General has identified as being caused by tobacco products. TRDRP will also support projects in which tobacco products or their constituents are integral to the proposed study.

Despite the overall decline in cancer death rates in the last two decades (see “Annual Report to the Nation on the Status of Cancer”), disparities in cancer incidence and death rates persist even with greater public knowledge of cancer prevention and recent innovations in cancer screening and treatment. Certain populations, such as African Americans and other racial-ethnic minorities, Californians who live in rural areas or have household incomes below the poverty line and members of the LGBTQ community, smoke at disproportionately high rates and thus have higher rates of cancer diagnoses and mortalities. These facts underscore the need for impactful research on the effective dissemination of cancer prevention strategies and the implementation of evidence-based policy and practice interventions that can reduce the cancer burden in specific cultures and communities that are disproportionately affected by tobacco-related cancer. For instance, personal health care decisions, such as whether or how often to undergo cancer screening or whether to participate in clinical trials, are often influenced by policies governing health care insurance coverage and practice recommendations provided by health care providers. Studies have shown that changes in some current policy and practice recommendations may result in improved cancer surveillance and/or survival in underserved communities. It is therefore important to conduct research with the goal of determining and overcoming the barriers to implementing system change and designing strategies to bring innovative healthcare solutions for tobacco-related cancers to all Californians.

The persistent high rate of cancer incidence and death among tobacco product users also underscores the need for continued research into the basic mechanisms of how tobacco products drive initiation and malignant progression of cancer and for the development of effective early detection techniques and precision medicine therapeutic strategies. As new therapies are developed, attention also must be given to understanding the basic mechanisms of drug resistance, which often leads to disease recurrence even with the most effective therapies. For the development of therapeutic strategies, TRDRP places emphasis on those that can be implemented in remote, under-resourced clinics or that are targeted to specific cultures and communities that bear a high tobacco-related cancer burden.

An important area of research relates to new and emerging tobacco products. A recent consensus study report by the National Academies of Sciences, Engineering and Medicine concluded that switching from combusted tobacco cigarettes to e-cigarettes reduces exposure to numerous toxicants and carcinogens present in combusted tobacco cigarettes. However, e-cigarettes contain highly variable amounts of potentially toxic substances and there is no available evidence from adequate long-term animal bioassays of e-cigarette aerosol exposures to inform cancer risk. Similarly, it is unknown whether or not e-cigarette use is associated with intermediate cancer endpoints in humans. The continuously changing landscape of electronic nicotine delivery systems poses a particular challenge to understanding their health effects. TRDRP is especially interested in studies that investigate the effects of new and emerging tobacco products, or their individual constituents such as flavorants and nicotine, on cancer risk. In never smokers, what is the harm of e-cigarette use? In smokers who completely switch to e-cigarette use, is there a relative benefit or is there additional harm of e-cigarette use? 

Sub-focus areas and example of relevant research topics:

Development and dissemination of effective cancer prevention strategies for California populations disproportionately impacted by tobacco-related cancer.

  • Behavioral, clinical and/or pre-clinical studies on preventing tobacco-related cancers
  • Studies of effective methods for disseminating existing prevention programs into low income communities
  • Develop and assess effectiveness and dissemination approaches for a tobacco-related cancer prevention program designed for Vietnamese males

Implementation of evidence-based health care policy and/or practice changes that show promise for reducing tobacco-related cancer deaths and health disparities in California.

  • Evaluation of emergency room intake procedures and their ability to identify patients at risk for tobacco-related cancer; design and assessment of effective approaches to inform those patients of the benefits of cancer screening
  • Evaluation of the quality/effectiveness of information about lung cancer screening and proximity to low-dose computed tomography (CT) services in California’s Central Valley
  • Development of a combined behavioral and medical health care team approach to increasing the racial and ethnic diversity of clinical trial cohorts

Translational research studies of new detection and treatment strategies for tobacco-related cancers

  • Therapeutic efficacy studies of new biologics in small or large animal models of tobacco-related cancers
  • Development of “theranostic” molecular imaging methods for simultaneous diagnosis and treatment of tobacco-related cancer
  • Development of effective early detection techniques and precision medicine therapeutic strategies tailored to African-American lung cancer patients
  • Studies of innovative patient care strategies to improve response to therapy and/or quality of life for patients with pancreatic cancer

Palliative care interventions for seriously ill cancer patients and their families in rural areas

Basic research studies of the molecular genetic mechanisms of tobacco-related cancer initiation, progression and resistance to therapy

  • Characterization of newly discovered genetic or epigenetic alterations in lung cancer
  • Molecular studies of the initiation and malignant progression of hepatocellular carcinoma
  • Pathways in the development of resistance to PD-1/PD-L1 targeted immunotherapies in tobacco-related cancers
  • Evaluation of the effects of e-cigarette use or e-liquid constituents, such as nicotine or flavorants, on disease progression in small cell lung cancer
  • The role of tobacco products in the initiation and progression of breast cancer