Addressing cancer disparities in Nigeria through Immuno-oncology Research – The NOLA Program

PROJECT SUMMARY – OVERALL In the US and other high-income countries, immunotherapy is transforming the management of some cancers, including colorectal cancer (CRC). However, immunotherapy is not widely available to patients in low- and middle-income countries (LMICs) who might benefit the most. Our collaborations in sub-Saharan Africa over the

past 10-years have highlighted disparities for Nigerian patients diagnosed with CRC – 53% of Nigerian CRC patients will die within a year of diagnosis, compared to 17% in the US – and incidence in Nigeria is rising. Interestingly, in work to understand the biological underpinnings of these disparities, we found a 3-fold higher

rate of the immunogenic MSI-H (high microsatellite instability) phenotype in Nigerian compared to US CRC, suggesting a unique opportunity to address CRC disparities in Nigeria with immunotherapy. Based on these findings, we are separately initiating the first prospective trial of immunotherapy for MSI-H CRC in sub-Saharan

Africa. While promising, our work in this area has illuminated the severe lack of immuno-oncology data from Nigerian patients (and other LMIC populations) at all scientific levels. Bringing the promise of immunotherapy to these populations requires a contextual understanding of CRC immunobiology, biomarkers to efficiently and

cost-effectively select patients most likely to benefit from treatment, and regional immuno-oncology experts with knowledge of immunotherapy and immune-related side effects. To address these needs, we will establish the Nigerian Immuno-Oncology Research (NOLA) program, with a goal to synergize our existing strengths in global

cancer disparities research and immuno-oncology that have, until now, lacked an integrated focus and coordination. Specifically, in this P20 project, we will unite a multi-disciplinary group to 1. develop pilot data to guide future studies investigating the tumor microenvironment of Nigerian CRC; 2. integrate a multi-disciplinary

team and research projects focused on immuno-oncology in Nigerian and US cancer patients; and 3. develop biobanks and databases of Nigerian CRC to support future immuno-oncology research. By the end of the project period, we will have generated the preliminary data, resources, infrastructure, and program plan to support a

robust multi-disciplinary, collaborative immuno-oncology research to address health disparities between Nigerian and US patients with CRC beyond the P20.