Through hurricanes, power outages, earthquakes, and even a global pandemic, collaborative research to improve outcomes in the Hispanic/Latino population is alive and active.

Moffitt Cancer Center’s partnership with Ponce Health Sciences University in Puerto Rico could have been compromised following the devastation of Hurricanes Irma and Maria in 2017, which brought widespread destruction and power loss.

Frozen tissue samples gathered over the past 10 years from cancer patients and healthy “controls” in Puerto Rico were moved to safe storage at Moffitt, as backup generator power on the island was running out. The thousands of samples, critical to research and personalized medicine efforts in the Hispanic population, remained in Moffitt’s care while Puerto Rico continued to rebuild electricity infrastructures.

In 2018 tissue collection had resumed and the facilities at Ponce were back up and running. “Moffitt planned to return the samples to the island after the 2019 hurricane season,” said Dr. Doug Cress, co-director of the Puerto Rico Biobank. About a week before the anticipated return, however, plans were thwarted when the backup generator failed to operate following a power outage. This was followed by earthquakes in late 2019 and early 2020. Now with travel restrictions related to COVID-19 and another hurricane season a couple weeks away, it appears the biosamples will be safely stored in biobank freezers at Moffitt for an indefinite time.

“The biosamples will be returned for storage in Puerto Rico once we are confident that the earthquakes are not a situation and the backup generator operates for extended period of time,” said Cress. He has an interest in the role that race, ethnicity, ancestry and genetics play in the molecular biology of lung cancer.

Meanwhile, through the Ponce/Moffitt partnership, samples are still being collected in Puerto Rico. “We have collected thousands of additional samples since they were first moved from the island to Moffitt,” said Cress. Moving forward, the samples are split so researchers in both Puerto Rico and Moffitt have a part of each tissue sample.

The initial and ongoing purpose of the partnership, funded through a federal grant, is to enhance health disparities research at Moffitt and cancer research at Ponce Health Sciences University, as well as cancer care in Southern Puerto Rico. A major goal of the partnership is increasing the number of researchers involved in cancer health disparities and growing the research and training.

While the overall purpose of the partnership remains, the research model itself is being enhanced. “Now that we have many samples, we are looking to see where we can make the most impact,” said Cress. “Our goal is to get tumors of 500 Hispanic patients sequenced with RNA labels. This is important, because this population is underrepresented in current databases.”

Data on the majority of the samples now is going to the Oncology Research Information Exchange Network (ORIEN), which is an alliance of cancer centers working in close collaboration to accomplish more in the fight against cancer, Cress noted.

"The outcomes data component had been missing for most biobanks, and it is important because it makes it possible to predict outcomes, such as whether a patient with certain mutations can do better or worse than someone without those mutations."

- Dr. Doug Cress, senior member, Molecular Oncology Department

This approach is tied closely to outcomes research. “The outcomes data component had been missing for most biobanks, and it is important because it makes it possible to predict outcomes, such as whether a patient with certain mutations can do better or worse than someone without those mutations,” said Cress. “This approach increases the power of your data and also decreases the number of samples that must be collected.”

In Puerto Rico, Dr. José A. Oliveras consents patients, reviews their charts for critical diagnostic information and follows up at regular intervals with consented patients who have donated tissue samples to determine their outcome. “The eventual availability of this level of clinical information combined with the extensive molecular data that we will obtain through ORIEN will represent an unprecedented dataset for Hispanics allowing us to identify critical cancer biomarkers,” said Cress.

An understanding of these genetic alterations among Hispanics is important. It will help assure that people in this population can be diagnosed accurately and receive appropriate therapy, the goal of personalized medicine. Physician-scientists sequence for mutations that are already known. But Hispanics may have mutations not yet discovered, and thus not included in current screening tests.

For example, Moffitt epidemiologist Dr. Peter Kanetsky, an active member of this partnership with Ponce, is studying a protein that if mutated, those who have the mutation no longer tan well. Whether one tans badly or tans well is a strong predictor of whether one will develop melanoma.

Another joint project related to outcomes involves the study of breast cancer in Latina patients. Existing data indicates that ancestry relates to outcomes for patients with breast cancer.

“For example, we know that women with African American ancestry have a risk of triple-negative breast cancer,” said Cress. This type of breast cancer grows and spreads fast, has limited treatment options and worse outcomes. “Other ancestries come into play. Latina ancestry is a mix of African American, indigenous American and European. It is interesting to research this to determine how ancestry affects the subtypes of breast cancer that women are diagnosed with and to know more about the outcomes.”