Risk of death for Black patients with HPV-negative oropharyngeal cancer (OPC) is significantly worse compared to White, Hispanic, and Asian patients even after adjusting for socioeconomic, demographic and disease related effects. Survey data suggests that Black, Hispanic/Latino and White patients agree that non-White patients with cancer are more likely than White patients to receive poor quality care. <5% of the oncology workforce (i.e. medical, surgical, radiation oncology etc.) identifies as an underrepresented minority (URM), which has implications for racial bias, discrimination, and cultural compentency. The scientific premise of this proposal is based on the integration of spatial transcriptomics and artificial intelligence (AI) pathomics to conduct a differential expression analysis between Black and White patients with HPV-negative OPC. We have previous experience using these approaches as a basis to understand gene expression changes between Black and White patients with HPV-positive OPC, which is a distinct neoplastic entity when compared to HPV-negative OPC. Therefore, we will identify differences in gene expression and stromal and immune cell topology between Black and White patients to identify biologic mechanism(s) that underlies racial disparities with respect to oncologic outcomes. Moreover, within this research proposal, in partnership with minority serving schools, we will create two pathways to address the disparity in the oncology workforce, including translational research. We will address these gaps in the field by pursuing the following specific aims: In Aim 1, we will determine spatial gene expression differences Black vs. White patients with HPV-negative OPC. In Aim 2, we will integrate spatial genomics and AI-guided pathomics between high vs. low pathomic expression within tissue types, controlling for self-reported race and genetically determined ancestry. To address the gap in URM in the oncology workforce, in Aim 3 we will work in partnership with City of Medicine Academy and Howard University to provide a longitudinal oncology research experience for high school students and surgical residents. In Aim 4, we will provide a laboratory incubator space in which URM Duke Faculty will be embedded to pursue cancer research, along with mentoring from experienced and committed mentors. We propose to address these important issues and lack of reliable biomarkers for all patients by integrating state-of-the-art techniques in genomics, pathomics, and AI, in a setting fostering diversity and inclusion. The data generated will be of benefit to all patients with HPV- negative OPCs as we are presently unable to identify poor responders regardless of race.

Risk of death for Black patients with HPV-negative oropharyngeal cancer (OPC) is significantly worse compared to White, Hispanic, and Asian patients even after adjusting for socioeconomic, demographic and disease related effects. Survey data suggests that Black, Hispanic/Latino and White patients agree that non-White patients with cancer are more likely than White patients to receive poor quality care. <5% of the oncology workforce (i.e. medical, surgical, radiation oncology etc.) identifies as an underrepresented minority (URM), which has implications for racial bias, discrimination, and cultural compentency. The scientific premise of this proposal is based on the integration of spatial transcriptomics and artificial intelligence (AI) pathomics to conduct a differential expression analysis between Black and White patients with HPV-negative OPC. We have previous experience using these approaches as a basis to understand gene expression changes between Black and White patients with HPV-positive OPC, which is a distinct neoplastic entity when compared to HPV-negative OPC. Therefore, we will identify differences in gene expression and stromal and immune cell topology between Black and White patients to identify biologic mechanism(s) that underlies racial disparities with respect to oncologic outcomes. Moreover, within this research proposal, in partnership with minority serving schools, we will create two pathways to address the disparity in the oncology workforce, including translational research. We will address these gaps in the field by pursuing the following specific aims: In Aim 1, we will determine spatial gene expression differences Black vs. White patients with HPV-negative OPC. In Aim 2, we will integrate spatial genomics and AI-guided pathomics between high vs. low pathomic expression within tissue types, controlling for self-reported race. To address the gap in URM in the oncology workforce, in Aim 3 we will work in partnership with City of Medicine Academy and Howard University to provide a longitudinal oncology research experience for high school students and surgical residents. In Aim 4, we will provide a laboratory incubator space in which URM Duke Faculty will be embedded to pursue cancer research, along with mentoring from experienced and committed mentors. We propose to address these important issues and lack of reliable biomarkers for all patients by integrating state-of-the-art techniques in genomics, pathomics, and AI, in a setting fostering diversity and inclusion. The data generated will be of benefit to all patients with HPV- negative OPCs as we are presently unable to identify poor responders regardless of race.