Where Do Prouty Donations Go? Spring, 2019

Jennifer Shell at lab table

We will look at a series of drugs traditionally used to treat pancreatic cancer that we have combined with the vitamin B-12 drug delivery system for their ability to selectively destroy pancreatic cancer tumors in conjunction with radiation therapy.

Jennifer Shell, PhD

The Prouty is an annual two-day athletic event to raise funds to support cancer research and support services for cancer patients at Dartmouth-Hitchcock Norris Cotton Cancer Center (NCCC). Thanks to the money raised by Prouty participants, researchers are identifying how to minimize colorectal cancer risk after weight loss surgery, the impact of state Medicaid expansion to cancer patients and new treatments for pancreatic cancer.

Minimizing colorectal cancer risk after weight loss surgery

Weight loss surgery is an effective method for promoting weight loss. However, the surgery may also lead to decreased fiber intake and resulting changes in the gut microbiome that may increase colorectal cancer risk. Diane Gilbert-Diamond, ScD, and her research team are trying to determine how bariatric surgery influences dietary fiber intake and gut microbiome. The team asked trial participants to report on their diet before and after surgery, and to collect small amounts of stool before and after surgery. The team can then sequence the genetic material present in the stool to determine the amount and type of bacteria that are present. “Some gut bacteria are thought to be protective against colorectal cancer,” says Gilbert-Diamond. “We would like to understand if the amount of this type of bacteria changes after bariatric surgery and, if so, how to maintain as much of this beneficial bacteria as possible.” The team hopes that their research will add to the overall understanding of how to maximize health benefits and minimize cancer risk after weight loss surgery. “Increasing our understanding of how weight loss surgery impacts the gut microbiome may help us to develop interventions to maximize patient health and minimize cancer risk following the surgery,” says Gilbert-Diamond.

State Medicaid expansion impacts cancer care

Another Prouty Pilot study led by Andrew Loehrer, MD, MPH, evaluates how state Medicaid expansion impacts access to and disparities in cancer care. Uninsured and underinsured individuals are more likely to already have advanced cancer at the time of diagnosis, and less likely to receive surgery intended to cure some common types of cancers. “The Affordable Care Act expanded insurance coverage to millions of Americans, largely through expanded Medicaid eligibility, and early data suggest that it was associated with earlier diagnosis of select cancers,” says Loehrer. “However, far less is known as to how general these trends are across different states that have various styles of Medicaid.” The team predicts that Medicaid expansion will be associated with earlier stage of cancer at the time of diagnosis and increased likelihood of receiving surgery intended to cure these cancers. They are using state cancer registries to compare changes in diagnosis and treatment of cancer for patients in both Medicaid expansion states and states that did not expand Medicaid eligibility. Advanced statistics will be used to evaluate whether the Medicaid expansion was independently associated with improved care. “This study will lay the foundation for additional work evaluating the influence of individual state Medicaid policy on disparities and equity in cancer care,” says Loehrer.

Improving drug delivery and treatment of pancreatic cancer

Jennifer Shell, PhD, and her team are looking to create a better treatment outlook for pancreatic cancer patients by combining drugs traditionally used to treat pancreatic cancer with the vitamin B-12. This drug delivery system is known for its ability to selectively destroy pancreatic cancer tumors in mice in conjunction with radiation therapy. “This combination treatment will be compared to radiation treatment alone to see if it gives an enhanced effect by utilizing drugs that are activated by the radiation dose,” says Shell. “These drugs are related to vitamin B-12, which is an essential nutrient and therefore nontoxic when administered even when attached to traditional chemotherapeutic drugs. We have found that this B-12 system is selective for tumors, since rapidly dividing cancer cells have an enhanced demand for this vitamin.” The team has been able to selectively transport drugs to pancreas tumors, a notoriously difficult tumor type for drug delivery. “A drug adapted to the vitamin B-12 platform can enter the cell disguised as vitamin B-12, and is only activated when illuminated with light coming from the radiation therapy,” says Shell. “This technology is readily delivered into pancreatic tumors and is activated only where needed, thereby reducing side effects and providing a more effective treatment.”

The 38th annual Prouty fundraiser to benefit Norris Cotton Cancer Center research will be held July 12-13, 2019. Learn more at theprouty.org.