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

Sloan-Kettering Inst Can Research, New York NY

Investigators

Abstract

PROJECT SUMMARY – OVERALL In the U.S. and other high-income countries, immunotherapy is transforming the management of some cancers, including colorectal cancer (CRC). However, these advances remain largely inaccessible to patients in low- and middle-income countries (LMICs), despite evidence suggesting they may derive substantial benefit. Our long-standing collaborations in sub-Saharan Africa have highlighted significant differences in CRC outcomes – 53% of Nigerian CRC patients will die within a year of diagnosis, compared to 17% in the U.S. – and incidence in Nigeria is rising. In exploring the biological basis for these outcome differences, we discovered a threefold higher prevalence of microsatellite instability-high (MSI-H) CRC among Nigerian patients compared to U.S. counterparts. This suggests a distinctive tumor immunobiology and a compelling rationale for therapeutic exploration. Based on these findings, we are separately launching the first prospective trial of immunotherapy for MSI-H CRC in sub-Saharan Africa. While promising, this work has illuminated the broader lack of immuno-oncology data from African populations. This data gap limits not only local clinical application, but also the generalizability of immunotherapy strategies globally, including in African-descended populations in the U.S. 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 immunotherapy, 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, leveraging our existing strengths in global cancer research and immuno-oncology to create a focused, coordinated initiative. Specifically, in this P20 project, we will unite a multi-disciplinary group to 1. generate pilot data to guide future studies investigating the tumor microenvironment of Nigerian CRC; 2. build a collaborative, multi-institutional research platform that integrates immuno-oncology efforts across Nigerian and U.S. cohorts; and 3. establish CRC biobanks and databases to support future immuno-oncology research. Training opportunities embedded in this project foster cross-cultural, systems-level thinking among U.S.-based early-career investigators, thereby expanding the breadth and resilience of the U.S. biomedical workforce. This program strengthens the U.S. cancer research enterprise by developing collaborative platforms that enhance biological insight, global preparedness, and scientific generalizability, particularly in populations of African ancestry who are insufficiently represented in existing datasets but significantly affected by cancer morbidity in the U.S.