This article was originally published on June 11, 2018 and was updated on Feb. 25, 2020.

New research focuses on finding better treatments for minority children with high-risk cancer malignancies, a group whose outcomes and survival rates are worse than other pediatric patients.

The multi-institutional project, led by Michigan Medicine C.S. Mott Children Hospital, includes clinical sequencing of a multi-ethnic cohort of pediatric cancer patients from Ann Arbor, Detroit and Flint. The research focuses on further understanding cancer biology in minority children as well as other factors, including socioeconomic backgrounds and access to care, which may contribute to disparities in outcomes.

The Children's Hospital of Michigan Foundation in 2018 awarded a $592,100 grant for the project, which is a collaboration between Mott and Children's Hospital of Michigan along with support from the Chad Carr Pediatric Brain Tumor Center at Michigan Medicine. The project launched in July, 2019.

"We have seen tremendous improvement in outcomes of children with cancer, but survival for those with recurrent or metastatic disease remains dismal — and outcomes are even worse for minority children," says lead researcher Rajen Mody, MBBS, director of pediatric oncology at Mott. 

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"This research is aimed at providing critical insights into the tumor biology of minority children, which will be key to developing innovative therapies. We are also trying to identify barriers that prevent minority and underprivileged patients in Detroit and Flint from accessing cutting-edge technology in the cancer field."

Researchers are studying tumor DNA and RNA along with normal DNA in a diverse population of child and adolescent cancer patients with relapsed or resistant rare tumors.

The current study includes 570 pediatric cancer patients, with 15% African American patients, 5% Middle Eastern patients and 5% of patients from other minority backgrounds.

The goal of the five year project is to ultimately include 35-40% African-American children and 10-15% children representing other minorities by prioritizing sequencing for tumors affecting minority patients.

Patients are being treated in a variety of health care settings, including urban academic (Children's Hospital of Michigan in Detroit), suburban academic (University of Michigan) and an urban community center (Hurley Medical Center in Flint).

"We are comparing the biological differences between malignant tumors of majority and minority populations in order to better understand the disparities in outcomes," Mody says.

'All of the potential causes'

Gene sequencing has shown promise in improving understanding of why certain cancers spread and resist treatment. Researchers are analyzing patients' tumor DNA/RNA as well as normal DNA to determine personalized cancer drivers, potential novel treatment options, reasons for treatment resistance and metastasis and individual drug metabolism.

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To identify new drug targets, researchers are also studying patients' tumor immune composition to predict responses to immunotherapy.  

Over the past several decades, overall five year pediatric cancer survival rates have increased significantly, from 63% between 1975 and 1979 to 79% between 1995 and 1999. But current data show Hispanic and black children and adolescents have poorer five year survival rates than their white peers.

"We need to look at all of the potential causes of disparities that lead to one group of pediatric patients faring worse than other children," Mody says. "Studying genetic differences that may contribute to outcomes, along with other factors including socioeconomic status and delays in diagnosis, will lay the groundwork for tailoring better treatments for this population."