3 research outputs found
The digital divide: Racial disparities in adoption and utilization of health information technology among patients with lymphoid cancers
Abstract Introduction Health information technology (HIT) has the potential to improve healthcare delivery and engagement. Studying racialâethnic disparities in HIT engagement will help understand and overcome challenges to healthcare utilization. Methods We undertook a patientâreported survey among patients with lymphoid malignancies at two campuses of Mayo Clinic, Florida to explore HITârelated disparities. Variables between Whites and nonâWhites, and nonâWhites from the two campuses were compared. Results The survey was completed by 1004 respondents, with 71% whites, 27% nonâWhites (raceâethnicity not reported by 2%). NonâWhites included 30% responders at the main campus and 64% at an innerâcity campus. Whites were significantly older and had higher education, while nonâWhites had lesser access to a computer. Only 51% of nonâWhites were registered to use electronic medical records (EMR) as compared to 72% Whites (pâ<â0.001) and significantly lesser number of nonâWhites even knew that EMR existed (81% vs. 92%, pâ<â0.001). Encouragingly, a higher number of nonâWhites wanted to engage in EMR. NonâWhites from the main campus were older, more educated and had more access to a computer as compared to those from the innerâcity campus. Similar disparate factors were noted among minorities from the two campuses, suggesting impact of socioeconomic backgrounds on EMR usage among nonâWhites. Linguistic barriers were more striking among innerâcity campus nonâWhites. Conclusions NonâWhites continue to struggle with suboptimal utilization of the healthcare system and barriers related to integration in HIT, including disparities representing socioeconomic differences. Efforts need to be made at several levels to help racialâethnic minorities overcome awareness, access, and linguistic barriers to HIT utilization
Th17-inducing dendritic cell vaccines stimulate effective CD4 T cell-dependent antitumor immunity in ovarian cancer that overcomes resistance to immune checkpoint blockade
Background Ovarian cancer (OC), a highly lethal cancer in women, has a 48% 5-year overall survival rate. Prior studies link the presence of IL-17 and Th17 T cells in the tumor microenvironment to improved survival in OC patients. To determine if Th17-inducing vaccines are therapeutically effective in OC, we created a murine model of Th17-inducing dendritic cell (DC) (Th17-DC) vaccination generated by stimulating IL-15 while blocking p38 MAPK in bone marrow-derived DCs, followed by antigen pulsing.Methods ID8 tumor cells were injected intraperitoneally into mice. Mice were treated with Th17-DC or conventional DC (cDC) vaccine alone or with immune checkpoint blockade (ICB). Systemic immunity, tumor associated immunity, tumor size and survival were examined using a variety of experimental strategies.Results Th17-DC vaccines increased Th17 T cells in the tumor microenvironment, reshaped the myeloid microenvironment, and improved mouse survival compared with cDC vaccines. ICB had limited efficacy in OC, but Th17-inducing DC vaccination sensitized it to anti-PD-1 ICB, resulting in durable progression-free survival by overcoming IL-10-mediated resistance. Th17-DC vaccine efficacy, alone or with ICB, was mediated by CD4 T cells, but not CD8 T cells.Conclusions These findings emphasize using biologically relevant immune modifiers, like Th17-DC vaccines, in OC treatment to reshape the tumor microenvironment and enhance clinical responses to ICB therapy
AT-101 Enhances the Antitumor Activity of Lenalidomide in Patients with Multiple Myeloma
Bcl-2 and Mcl-1 proteins play a role in multiple myeloma (MM) cell survival, for which targeted inhibitors are being developed. AT-101 is an oral drug, which disrupts Bcl-2 and Mcl-1 function, impedes mitochondrial bioenergetic processes and induces apoptosis in MM cells. When combined with lenalidomide and dexamethasone (Rd), AT-101 significantly reduced tumor burden in an in vivo xenograft model of MM. These data provided rationale for a phase I/II study to establish the effective dose of AT-101 in combination with Rd (ARd regimen) in relapsed/refractory MM. A total of 10 patients were enrolled, most with high-risk cytogenetics (80%) and prior stem cell transplant (70%). Three patients were lenalidomide-refractory, 2 were bortezomib-refractory and 3 were daratumumab-refractory. The ARd combination was well tolerated with most common grade 3/4 adverse events being cytopeniaâs. The overall response rate was 40% and clinical benefit rate was 90%. The median progression free survival was 14.9 months (95% CI 7.1-NE). Patients responsive to ARd showed a decrease in Bcl-2:Bim or Mcl-1:Noxa protein complexes, increased CD8+ T and NK cells and depletion of T and B-regulatory cells. The ARd regimen demonstrated an acceptable safety profile and promising efficacy in patients with relapsed/refractory MM prompting further investigation in additional patients