Researchers at Vanderbilt Health have found that a balance of two closely related cell surface proteins may be critical to the health of the epithelial lining of the gastrointestinal tract, and for suppressing tumor formation in the colon.

The surface proteins are LRIG1, a tumor suppressor, and its cousin LRIG3, for which there have been conflicting reports about whether it cooperates with or opposes the action of LRIG1.

“We show that a balancing act between LRIG1 and LRIG3 keeps a powerful driver of colorectal cancer in check,” said Robert Coffey Jr., MD, Ingram Professor of Cancer Research and Professor of Medicine. “This offers potentially new avenues to explore in the treatment of colorectal cancer.”

Coffey is corresponding author of the report published Aug. 31 in the journal Cellular and Molecular Gastroenterology and Hepatology. Co-director of the Vanderbilt Epithelial Biology Center, he is internationally known for his research on mechanisms that drive the development of colorectal cancer, one of the nation’s leading cancer killers.

In 2012, Coffey and his colleagues found that removal of one copy of the Apc gene, the colon cancer “gatekeeper,” in LRIG1-expressing cells results in multiple colonic tumors.

Now they show that removal of both copies of theLrig3 gene in this setting drastically reduces tumor formation, highlighting the antagonistic nature of the LRIG proteins. This suggests that LRIG1 and LRIG3 work together to maintain the balance of cell signaling pathways implicated in cancer.

Matthew Bechard, PhD, was the paper’s first author. Other Vanderbilt co-authors were Zhengyi Chen, Ping Zhao, PhD, Radhika Aramandla, Yilin Yang, Alan Simmons, Kay Washington, MD. PhD, Jeffery Franklin, PhD, and Ken Lau, PhD.

The research was supported in part by the National Cancer Institute (grant R35CA197570), a GI SPORE grant (P50CA236733), and by the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation.

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For years, care incidence gaps were chalked up to money, insurance and getting to the doctor. While those factors are important, they miss one critical detail: that genes and ancestry shape how cancer develops, proving that no two patients are exactly alike.

“Often, we assume that the reason for most gaps in health care outcomes is an inability to access health care, as some patients simply cannot get transportation to get to the hospital or doctors’ appointments, or they lack insurance,” said Somedeb Ball, MBBS, Assistant Professor of Medicine in Hematology/Oncology at Vanderbilt-Ingram Cancer Center. “But in addition to those factors, we must recognize scientifically that we are not all the same. Understanding the biologic differences in genes and ancestry can provide insights into delivering personalized care.”

Ball, who studies genetic mutations in acute myeloid leukemia (AML), an aggressive blood cancer that has a five-year survival rate of only 30%, set out to investigate and get some answers.

The Problem: A Long-Standing Blind Spot

AML is predominantly diagnosed in white populations, and in turn, up to 90% of clinical trial participants are white. As a result, standard classification criteria, risk stratification models, and approach to targeted therapies have been heavily skewed toward European ancestry, which left big gaps in care for patients of color, particularly Black patients.

But AML is driven by complex combinations of multiple genetic mutations rather than a single defect, so targeted therapies designed around European genetic profiles often fail or lead to treatment resistance in other races and ethnicities.

To address this problem, Ball collaborated with Chidiebube Ugwu, MD, of Jefferson Einstein Philadelphia Hospital, and Jude Ossai, MD, of Newark Beth Israel Medical Center. The research team analyzed American Association for Cancer Research (AACR) Project Genomics Evidence Neoplasia Information Exchange (GENIE) data from 2,359 patients with AML (243 Black and 2,116 white) to examine how mutational landscapes differ by race.

The Key Findings: A Distinct Biological Profile

The study revealed significant biological differences in Black AML patients that directly challenge current “race-blind” risk models:

• Lower splicing factor mutations: Black patients exhibited lower rates of splicing factor gene mutations compared to white patients.
• Unexpected early-onset mutations: Black patients under age 40 showed a significantly higher prevalence of myelodysplastic syndrome-related mutations, such as ASXL1.
• Unique co-mutations: Distinct co-mutation patterns were identified in Black patients, particularly involving the RAS/MAPK signaling pathway.
• Altered prognostic indicators: Mutations traditionally classified as “favorable” (such as NPM1) provided protective survival benefits in white patients but failed to do the same in Black patients.

“Because existing risk stratification models were built on data from white patients, we must update how we categorize risk to ensure precision care for Black patients,” Ball said.

The Solutions: Re-Evaluating Guidelines and Expanding Clinical Access

These findings underscore that AML cannot be treated with a “one-size-fits-all” strategy. Shared at the 2026 ASCO Annual Meeting and featured in Specialty Pharmacy Continuum, the team’s research highlights an urgent need for the academic community to incorporate ancestry-specific differences into clinical guidelines.

Moving forward, Ball cited two changes that would work toward a more full understanding of AML: actively recruiting a broad and representative cohort of participants in clinical trials, while expanding genomic testing in community settings.

“Expanding access to genomic tools helps doctors understand the drivers of each patient’s cancer, while robust trial participation ensures new therapies benefit everyone and are applicable to people of all racial and ethnic groups,” he said.

Achieving this will require proactive outreach.

“It is our responsibility as investigators and physicians to meet patients where they are, address their concerns, and clearly communicate how participating in research helps both them and future patients. Building truly inclusive precision oncology requires a unified, comprehensive effort from the top down,” Ball said.

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Vanderbilt-Ingram Cancer Center has spent years assembling cancer teams — medical oncologists, surgeons, radiologists, pathologists — in Tullahoma, Spring Hill, Wilson County and beyond.

Proximity is a priority. Advances in immunotherapy and targeted treatment mean many cancers, even advanced ones, are now managed for years rather than months, meaning patients can spend a lot of time on the road to see their care team.

“The goal of treatment is to facilitate your life, not to put your life on hold,” said Laura Goff, MD, MSCI, Executive Medical Director of the Cancer Patient Care Center.

Goff and Waleed Khalaf, MD, PhD, Medical Director for Regional Network Cancer Care, talk about why the evolution of cancer treatments makes mid-state locations essential.

Next month, Community Impact will introduce the people making that shift possible — some of whom grew up in the towns they now practice in. We’ll spotlight the team behind Vanderbilt-Ingram’s regional cancer clinics and revisit the milestones that got us here, such as Cool Springs, which opened in 2001; Wilson County’s radiation oncology growth; and Clarksville’s decades-old radiation program. … And more.

Q: If you were talking at a Chamber of Commerce in Middle Tennessee about the latest generation of cancer care and how Vanderbilt-Ingram Cancer Center impacts their community, what would you say?

Goff: Cancer care is impacting everybody’s community. At this point, Vanderbilt-Ingram sees patients who come from great distances to access leading-edge cancer therapies. Cancer care delivery requires a mix of groundbreaking technology and attentiveness, providing much of that care within the context of a patient’s everyday life. Their life goes on. They need to try to work. They need to try to take care of their kids. We want that for them.  

Often cancer care goes on for weeks and weeks, and many times even years, so traveling three, four hours round trip on a weekly basis can be a strain on patients. What we are trying to do, Waleed and I together, is get the services we can as local as we can to facilitate the highest quality care in Tennessee towns.

The highly specialized treatments will be done at the Main Campus in Nashville . Thankfully, those are not usually treatments that are needed continually long term or able to be offered everywhere. The value of having Vanderbilt-Ingram as your local provider is the seamless transition to those highly subspecialized things that exist within our network. If you go to Vanderbilt-Ingram, we have that deep expertise. We don’t have to refer you somewhere else.

Khalaf: The main point of emphasis that we would want to highlight is exactly that — bringing that care closer to where our patients live outside of the Main Campus. If you’re somebody living in Spring Hill, for example, we’re in your backyard, and we’re bringing that care closer to you. Cancer care nowadays is provided by a team, of course. It’s not just one person, so we bring the whole team to our regional clinics.

There’s this idea floating around that specialists are only available in Nashville. But we want to underline that Vanderbilt-Ingram specialists are around Middle Tennessee. Your care journey can start with us — and should start — with our specialists who are down the street.

Q: What does it mean to bring that kind of hope to people who perhaps didn’t think this kind of care was available in the neighboring county?

Goff: Waleed does it and sees it every day. Our new acquisition in Clarksville, the excitement in patients I have seen on campus was palpable as soon as that was announced. They were so excited that Vanderbilt Health was coming to their community. We have a history of people driving from Clarksville, from Owensboro, and beyond. So, to know that Vanderbilt Health was investing in turning around a hospital — we certainly did it in Wilson County and the other locations too, and they were thrilled.

Khalaf: I think that’s exactly right. There are always sensitivities, I think, when we bring a big name to a small community. There are always challenges navigating that. The people, yes, they are excited, very open, but there are some fixtures in the community that are always sensitive and think you’re coming to just bulldoze and take over and change everything and fire everybody here. And that’s not the case. We’ve proven that in Wilson County especially, which has been a tremendous success.

Q: How has cancer care evolved in the last, say, 10 to 15 years — and is that partly a reason why decentralizing the care is possible now?

Khalaf: The model of driving three hours to a big hospital to get care is changing. People expect to get care closer to where they live, and we’re trying to match that expectation. At the same time, things are changing dramatically at the level of therapeutics and advances. People are living longer and longer with cancer, and it’s really becoming a chronic medical problem as treatments evolve.

A lot of our treatments are now non-chemotherapy treatments; they’re targeted treatments. A lot of them are pills people take at home — they don’t have to come in for an infusion. A lot of them are immunotherapy treatments. A lot of them enable our patients to continue to live life as close to normal as possible while they are dealing with this chronic illness and receiving treatment.

Goff: What we’re really trying to look at is how we can fit more seamlessly into a patient’s life. I tell patients that the goal of treatment is to facilitate your life, not to put your life on hold. If you have a cancer that is very treatable but not curable, you’re going to be on treatment for a long time. We have to find a way to make treatment fit into your life, without placing any more burden on you than is already there.

This a team sport — it’s not just one oncologist who can alone provide adequate cancer care. The Vanderbilt-Ingram model is that we rely on a team of doctors, our surgical oncologists, our expert radiologists, the deep pathology expertise.All of those specialties are necessary to really take adequate care of a cancer patient. It’s one of the values of getting your care at a Vanderbilt Health system rather than a one-off doctor’s office.

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Vanderbilt Health has received a five-year, $3.4 million Academic-Industrial Partnership grant from the National Cancer Institute to support development of magnetic resonance (MR) cytometry as a new tool for breast cancer imaging.

MR cytometry is a magnetic resonance imaging technology pioneered by Vanderbilt Health investigators that provides information about tumor microstructure which cannot be obtained from conventional MRI.

Junzhong Xu, PhD, Director of Cancer Imaging Research at the Vanderbilt University Institute of Imaging Science (VUIIS), is principal investigator of the project. He will work with VUIIS Director John Gore, PhD, and with grant co-investigator Ryan Robison, PhD, MR Clinical Science Leader for North America at Philips Healthcare.

The investigators will integrate the technique into existing clinical MRI systems and develop a quality control system to support consistent use across scanners and institutions. They will then work with researchers from the University of Washington in Seattle to evaluate this technology in clinical breast cancer imaging.

This project “represents an important step in translating a Vanderbilt-developed imaging technology into a tool that could eventually be used in routine clinical care,” Xu said. “Working closely with Philips allows us to address the technical challenges required to move the method beyond a research environment and toward broader clinical use.”

Despite significant advances in early detection and treatment in recent years, breast cancer remains a leading cause of cancer mortality in women. Tissue biopsies provide essential diagnostic information but may provide an incomplete picture of the tumor and are difficult to repeat frequently over the course of treatment.

MR cytometry uses advanced diffusion MRI technology, including oscillating gradient spin echo, to probe how water molecules move within tumors at micrometer length scales. Advanced data acquisition and analysis of this movement enable researchers to estimate mean cell size and cell density noninvasively.

Combining biopsy findings with MR cytometry could give clinicians a more complete picture of a tumor and potentially help guide treatment decisions.

“The ability to measure cell size, cell density and other microstructural features using oscillating gradient diffusion imaging is immensely exciting, given its potential to monitor disease progression and inform clinical decision-making,” Robison said.

“Working alongside Dr. Xu and the team at VUIIS is a tremendous privilege, as they are the pioneers of this technique and are widely recognized as the world leaders in its development, validation and clinical translation,” he said.

“We have had a strong relationship with Philips for over 20 years, and it is encouraging to obtain funding that will be of mutual benefit and help patients,” said Gore, University Distinguished Professor of Radiology and Radiological Sciences, and holder of the Hertha Ramsey Cress Chair in Medicine.

Xu, Associate Professor of Radiology and Radiological Sciences, said MR cytometry has the potential to be applied to imaging other cancers and diseases in which changes in cellular microstructure are important.

The NCI Academic-Industrial Partnership grant (R01CA308592) supporting the research is designed to move promising technologies toward clinical use through collaborations between academic and industry partners.

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The Neurofibromatosis and Schwannomatosis Patient and Family Symposium will be held virtually Saturday, Aug. 22, from 9 a.m. to noon. The symposium is free and open to people affected by neurofibromatosis and schwannomatosis, as well as their families, loved ones and caregivers.

Neurofibromatosis (NF) and schwannomatosis are genetic disorders that predispose patients to develop tumors of the nervous system. NF1, the most common form of neurofibromatosis, affects approximately 1 in 2,500 births. Tumors associated with these conditions can occur throughout the nervous system, including the brain, spinal cord and peripheral nerves. Most are benign, although a small number can become cancerous.

Alex Mohler, MD, MS, Associate Professor of Clinical Neurology in the Division of Neuro-Oncology and Director of the Vanderbilt-Ingram Cancer Center Neurofibromatosis Clinic is the symposium chair.

“Until recently, we have had very few options for managing the challenges associated with these conditions,” Mohler said. “Our annual symposium brings the latest information directly to patients and families in our region who are affected by NF and schwannomatosis.”

Participants will receive updates on current treatment options, clinical programs and research initiatives available through Vanderbilt-Ingram. The event will highlight support services available for adults and children living with NF and schwannomatosis. Attendees will also learn about resources available through Vanderbilt Health partners NF Tennessee and the Children’s Tumor Foundation.

Click here to register.

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Jason Colee, a husband and father of two from Alabama, runs because it refreshes him physically and mentally. In the last three years alone, he has run (and won) multiple 5Ks, several 10Ks, three half-marathons, a 16.2-mile challenge in the Great Smoky Mountains, and even a full marathon.

Notably, just before all these achievements, he underwent a six-hour spine surgery at Vanderbilt University Hospital to remove a rare tumorous mass that was nestled inside his spinal cord.

Colee first noticed problems with his gait, was seen by his orthopedist and tried physical therapy. But after being diagnosed with a myxopapillary ependymoma, Colee’s doctors in Huntsville told him he needed to be seen by the best spine specialists there were.

“Fortunately, we live in North Alabama, and we know Vanderbilt’s got a stellar reputation,” said Colee.

He asked his doctor how soon he should be seen at Vanderbilt Health. “You need to be in there immediately,” was the doctor’s reply.

High risk, high reward

The following week, Colee and his wife, Jennifer, traveled to Vanderbilt-Ingram Cancer Center Belle Meade. He was quickly matched with Scott Zuckerman, MD, MPH, who Colee’s referring physician said would be the best neurosurgeon to handle his case.

“We took it day by day,” said Zuckerman. “We told him it’s a big, high-risk surgery. I couldn’t make any promises about what type of tumor it was or how tightly it was stuck to his spinal cord, but I think he had come to terms with that.”

Colee was admittedly very nervous. But in undergoing the surgery, he gave himself the best shot to preserve his ability to walk, which mattered for two reasons: his love of running and his family.

“There’s a chance that, at some point, you’re going to walk your daughter down the aisle and be there for your grandkids someday, hopefully,” Colee recalled his wife saying. “We’ve got to do this.”

Colee said the “we” mentality Jennifer emphasized helped restore his confidence that the surgery was the right course of action. He credited Jennifer’s resilience and the shared Christian faith of the family — which includes daughter, Emma, and son, Jake — for his ability to withstand the emotional impact of the ordeal.

“The risks were high, but the rewards were high also,” Colee said.

Nervous about his nervous system, Colee found his care team rose to the occasion

It makes sense that someone headed to anesthesia for spine surgery would be uneasy. Colee’s worry remained despite what he called excellent preoperative care. That’s when Zuckerman came to speak to him.

“This is the A-team,” Zuckerman told Colee. “Everybody you see in this room is the best at what they do.”

On one hand, getting the best of the best may signal that this is as serious as it gets. But on the other, it’s the ultimate assurance that a patient has found the right surgical team.

“The operating room is a serious, focused environment,” Zuckerman said. “But we go into any complex surgery with a really good plan, just like a coach would go into a basketball game with a focused game plan.”

Colee said he never fully conquered his nerves before the surgery.

“Vanderbilt is first-rate,” Colee said. “The process of getting there and everything they did to get me back and ready to go was top-notch; unlike anything we’d ever experienced. It was fantastic.”

Finally, thanks to the anesthesia, his worries subsided as he slipped into sleep. When he awoke, with the tumor out of his spine, he was hit with a wave of relief. Motor function testing showed that everything came back clear.

“I shouldn’t be this excited about being able to wiggle my dang toes,” Colee said. “I guess the gravity of it all hit me after the fact.”

Life after a spinal tumor was just as fulfilling as before

Colee was grateful that his rehabilitation care team wanted input on how he wanted to attack recovery.

“‘We’ve got guidelines we want you to follow and milestones we want you to hit, and it’s up to you how fast you hit those,’” Colee recalled being told. “The nurses let me do what I wanted to do when I wanted to do it as long as it was safe.”

In the end, Colee left the hospital only 48 hours after the conclusion of surgery, a remarkable outcome for a spinal operation.

Soon, Colee wondered when he could get back to running. Zuckerman said if he followed his recovery plan to the letter, it wouldn’t be long.

All told, it ended up only being a six-week hiatus before he put his running shoes on again. It was ugly, Colee said, “like a frog in a frying pan,” but he was moving.

Then came the 5Ks, 10Ks, half-marathons, 16.2-mile race and a full marathon this past spring.

But the most important thing Colee did with his legs didn’t come on the racecourse. It was, as his wife had foreseen, walking his daughter down the aisle.

“Everybody at Vanderbilt was invested in us getting back to where we wanted to be,” Colee said. “This was not guaranteed, even with the surgery. But I knew that Dr. Zuckerman and everybody involved in the process wanted to help me do what I wanted to, whether it was walking my daughter down the aisle or checking a marathon off the bucket list.”

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Nearly two decades ago, after being diagnosed with leukemia at age 7, Lily Hensiek promised to help other children diagnosed with cancer.

At the time, doctors at Monroe Carell Jr. Children’s Hospital at Vanderbilt explained her diagnosis through a simple analogy. Cancer was like weeds taking over a garden, they told her, and chemotherapy was the tool used to remove them. The idea inspired her family to create the Lily’s Garden Fund, a fundraising effort dedicated to advancing childhood cancer research, training and innovation.

Over the past 18 years, Lily’s Garden has funded pediatric cancer research, programs, lectureships, fellowship training and early-career investigators.

The family recently announced its latest commitment: $5 million to establish the Lily’s Garden Pediatric Leukemia Program at Monroe Carell to support leukemia research, physician-scientist leadership, precision oncology, innovative discovery projects and family-centered care initiatives. This gift brings the family’s total giving to $8 million. Family members have added to Lily’s Garden through personal giving, fundraising events, and the support of friends and community partners.

“We are so incredibly grateful to Lily’s family; they are absolutely amazing,” said Debra Friedman, MD, MS, Director of the Division of Pediatric Hematology and Oncology at Monroe Carell and Deputy Director of Vanderbilt-Ingram Cancer Center.

“This leukemia program will provide us the ability to continue to advance discovery for leukemia and then translate that discovery to patients in the clinic,” continued Friedman, holder of the E. Bronson Ingram Chair in Pediatric Oncology.

A Family Affair

The Lily’s Garden Fund has been a family affair. Joining Lily in the endeavor are her parents, Larisa and Phillip Featherstone; grandparents, Carol and Ron Johnston; and sisters, Sophie Hensiek and Sophia Featherstone.

The family, from Franklin, Tennessee, owns a workplace safety consulting and third-party claims administration firm, Johnston & Associates, which was founded by Ron. 

Lily was first diagnosed with pre-B cell acute lymphoblastic leukemia when she was in second grade. At the time, she set what felt like a lofty goal — raising $1 million for childhood cancer research.

“I never imagined when we started the Lily’s Garden Fund that it would go this far or become this big,” said Hensiek, who is now 25. “I’m very thankful that we’ve had the opportunity to do all of this and help support research.”

The family’s philanthropy journey began simply.

“Our first fundraiser was making soap,” said Larisa Featherstone, who also serves as Chair of the Monroe Carell Advisory Board. “Honestly, it felt insurmountable,” Featherstone said. “But it shows how something really small can compound over time, and every bit truly makes a difference.”

A New Era of Discovery

The newest gift is designed to accelerate the rapid progress in research. The gift will support a directorship to help advance pediatric leukemia care throughout the care continuum, including long-term survivorship; it will also create a directorship in cancer predisposition and precision oncology; and it will provide resources for innovative, high-impact research projects.

Hensiek knows firsthand how life-changing research can be. As a teen, she experienced a rare late relapse of acute lymphoblastic leukemia and benefited from an immunotherapy treatment previously unavailable when she was first diagnosed.

“Immunotherapy wasn’t really even a thing when I was 7 years old,” Hensiek said. “It’s really amazing to see how far research has moved forward.”

For the type of leukemia Hensiek had, cure rates have risen dramatically.

“When Lily was first diagnosed, we said there was probably somewhere around 85% to 90% cure,” Friedman said. “Now, with the same leukemia, due to advances, we’re at almost 98%.”

The program will also support mental health and family-focused initiatives — areas the family believes are essential.

“Childhood cancer affects the whole family,” Featherstone said. “It doesn’t just affect the child or the parent.”

A Full-Circle Moment

Today, Hensiek is doing well and preparing for a career in health care. In a full-circle moment, she is studying to be a physician assistant at Kansas State University and will graduate in May 2027. Inspired by the physicians and caregivers who helped save her life, she too hopes to help children with cancer.

She also had the opportunity to do some of her clinical training at Monroe Carell. “It was such a phenomenal experience,” she said. “I’ve been the patient, and now I’ve been the student. That’s kind of wild to think about.”

As Lily’s Garden enters its next chapter, the family hopes the new leukemia program will honor not only Hensiek’s journey, but also the many children and families they have met along the way.

“We just keep going until there’s a cure,” Hensiek said.

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Gastric cancer rarely develops overnight. Instead, chronic inflammation can trigger a series of changes in stomach tissue that progress from normal cells to precancerous lesions and eventually to cancer. But where the mystery lies is why do some precancerous lesions develop into cancer while others do not? 

A new study from Eunyoung Choi, PhD, and colleagues helps answer that question by identifying the cancer-associated transcription factor SOX9 as a critical factor in the progression of spasmolytic polypeptide-expressing metaplasia (SPEM), a cell type increasingly recognized as a precursor to gastric cancer. The research was published July 14 in the journal Gastroenterology.

“Normal gastric chief cells transition into SPEM cells, which are associated both with mucosal recovery and cancer development,” said Choi, Associate Professor of Surgery and holder of the Naji N. Abumrad Chair. “Although SPEM has been recognized for years, the mechanisms regulating its progression have remained unclear.”

During chronic gastric injury, mature gastric chief cells can transform into SPEM cells as part of the stomach’s repair process. While this response may initially be protective, persistent inflammation and cancer-promoting signals can cause these cells to acquire characteristics associated with cancer development.

To investigate SOX9’s role in this process, researchers used two mouse models of gastric injury and carcinogenesis along with human gastric tissue samples. They found that SOX9 is required for chief cells to transition into SPEM cells following both acute and chronic injury.

When the researchers genetically removed SOX9, metaplasia failed to develop. The loss of SOX9 also prevented progression toward cancer and allowed repair-associated progenitor cells to return to a more normal state.

“These findings suggest that SOX9 functions as a master regulator of the cellular plasticity that drives gastric cancer development,” Choi said.

The study also revealed that SOX9-dependent SPEM cells help recruit fibroblasts to the base of gastric glands, contributing to a tissue environment that supports tumor formation.

Additionally, investigators identified a distinct subgroup of SPEM cells that express TOP2A, a protein associated with cell proliferation. Human tissue analyses showed that cells positive for both SOX9 and TOP2A were linked to metaplastic progression, suggesting these markers may help identify precancerous lesions at greater risk of becoming cancerous.

The findings may have important implications for patient care.

“Finding metaplasia on a biopsy is relatively common, but predicting which lesions will progress to cancer has remained challenging,” Choi said. “SOX9 and TOP2A positivity along with other SPEM cell markers may help identify patients with a higher likelihood of progression.”

Beyond their potential use as biomarkers, the results also point to new therapeutic possibilities. Targeting the cellular pathways regulated by SOX9 could provide an opportunity to interrupt the cancer development process before invasive disease occurs.

The researchers concluded that SOX9 is a critical regulator of SPEM development, metaplastic progression and gastric carcinogenesis. Future studies will explore how these findings can be translated into improved risk assessment tools and preventive strategies for patients at risk for gastric cancer.

The paper’s first author was Alexis Guenther, a graduate student in Cell and Developmental Biology in the Choi lab. Other Vanderbilt co-authors were Amanda Ruelas, Brianna Caldwell, MBA, Youngwon Cho, PhD, Changqing Zhang, Judith Romero-Gallo, MS, and Richard Peek, MD.

The study was supported in part by the National Institutes of Health (grants F31CA284715, R37CA244970, R01CA272687, R01CA077955, P01CA116087, R01DK058587, R01CA281732 and P20GM121322), the American Gastroenterological Association Research Foundation, the U.S. Department of Defense, and the Vanderbilt University School of Medicine Stanley Cohen Innovation Fund.

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A new study of cancer drugs denied by Medicare Part D insurance plans found that more than one-fifth of denials were overturned upon review by a contracted reviewer. This suggests there are a considerable number of inappropriate denials.

The study, led by Youngmin Kwon, PhD, a postdoctoral research fellow in the Department of Health Policy at Vanderbilt Health, implemented natural language processing to analyze the text of second-level appeals of cancer drugs denied under Medicare Part D, the supplemental plans that cover prescription drugs. The study was published in JAMA Network Open.

“Cancer drugs are expensive, and their use is closely monitored and controlled by insurance plans. They also belong to a protected drug class in the Part D program, meaning that plans must cover all or nearly all of these drugs. While plans cannot broadly exclude coverage, they can deny coverage of drugs that are not deemed medically necessary,” Kwon said.

The most common reason for initial denials was “non-medically acceptable” indications, or drugs prescribed “off-label,” which generally means using a drug outside its formally approved indication by the Food and Drug Administration.

When treating cancer, prescription drugs are often combined or used for cancer types or populations that aren’t always specifically included in the FDA-approved labeled indication. To govern coverage of off-label use, Medicare relies on clinical compendia that summarize supporting clinical evidence or other peer-reviewed studies of medications prescribed off-label.

“Off-label prescribing is exceptionally common in oncology, especially for treating rare or treatment-resistant cancers. Because it does not follow the ‘standard’ treatment protocol, insurers may have a greater justification for heavily scrutinizing off-label use and refuse coverage,” Kwon said.

However, the study found that 88% of successful appeals for off-label use were for medically acceptable indications already supported by a Medicare-approved clinical compendium or peer-reviewed scientific literature, suggesting that many requests for acceptable off-label use may have been denied.

Further, appeals for off-label use were often denied due to clerical issues (72%), such as failure to include adequate documentation and supporting citations. This suggests that many coverage decisions may have been made purely on administrative grounds, rather than through a formal clinical review, Kwon said.

Among drugs prescribed on-label but that were initially denied for failing to follow the preapproval process, 60% were ultimately approved by reviewers, a higher rate of favorable review.

Kwon said these findings echo concerns that utilization management tools used by insurers, such as prior authorization, are imposing barriers to necessary and evidence-based care.

“Patients and their providers may face considerable administrative burden in the appeals process for coverage of drugs that could be lifesaving. A simple mishap, such as forgetting to attach a lab result or a supporting citation, could mean weeks of delay. This creates stress for patients and their care team and could even lead to worse health outcomes if care is substantially delayed.”

Kwon said the new findings can be helpful in ensuring that Medicare beneficiaries undergoing cancer treatment receive timely, high-quality medical care they need.

“Given the rapid adoption of AI into medical review processes, it will be important for Centers for Medicare & Medicaid Services and insurers offering Part D plans to continue to improve the coverage and appeals process for Medicare beneficiaries. For instance, reducing documentation burden for on-label therapies, while establishing clearer guidelines for determining effective off-label use by insurers, may go a long way in improving patients’ access to prescribed cancer drugs.”

The research was conducted in collaboration with researchers from the American Cancer Society, Emory University, the University of Pittsburgh and University of Hawai’i at Mānoa, and Wake Forest University.

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For two weeks this summer, 30 high school students were glued to their screens.

But instead of scrolling social media or streaming videos, they were learning about the world of cancer research and medicine through the Summer Healthcare Experience in Oncology (SHE) program at Vanderbilt-Ingram Cancer Center.

More than a summer virtual learning program, SHE gives students an opportunity to explore meaningful careers in STEM, cancer research and cancer care, and envision their place in the future of medicine. Through hands-on experiences, mentorship and exposure to leading researchers and clinicians, they gain valuable insight into the discoveries and innovations shaping the future of cancer care.

Program Director Kimberly Dahlman, PhD, said, “SHE bridges the gap between curiosity and real-world opportunity through a two-week virtual curriculum, an immersive campus visit day, and year-round professional development.

“Participants build core scientific knowledge through interactive instruction and team-based research simulations. They also explore a range of careers in cancer research and clinical care, gaining insight into pathways in medicine, public health and biomedical science,” she said.

Nearly 160 students from 58 high schools applied this year across the entire region served by Vanderbilt-Ingram, which spans Tennessee, Alabama and Kentucky. Twenty-five girls and five boys were accepted.

Throughout the school year, program engagement continues and includes virtual workshops in partnership with peer programs and opportunities to connect with mentors.

The program is financially supported by the American Cancer Society and Vanderbilt-Ingram.

Growth and Milestones in Year 5

Since its inception in 2022, SHE has scaled its impact dramatically. The 2022 cohort welcomed 20 students from Davidson County, Tennessee-based high schools, selected from over 70 applicants.

In 2023, the program received institutional support, which allowed the cancer center to expand recruitment across the full region served by Vanderbilt-Ingram and increase capacity from 20 to 30 students.

For the 2026 program year, Vanderbilt-Ingram received 158 applications from 31 counties.

Additional funding from Vanderbilt-Ingram helps cover expenses such as travel stipends and meals so that students outside Nashville, particularly those who live in rural areas, can experience the Vanderbilt Health Main Campus firsthand.

Students gave the program high ratings and provided positive feedback:

• 100% of respondents said the program provided them with a clear understanding of key cancer research principles.
• 94% of alumni that are currently enrolled in college stated that their current major or concentration was in a biomedical field.
• 9.1 was the average score on a scale of 1-10 for program impact.

One attendee shared, “(SHE) gave me the chance to explore science. Overall, it was an unforgettable experience that made me even more excited about science and health care.”

Another participant said, “I feel much more informed about my options for a future career in cancer research or medicine. I will never forget this experience.”

To help grow or support the program, make gifts online at https://bit.ly/viccshe. When making a gift, please select “Other” under “What would you like your donation to support?” Then in the comment field below, please write in “Summer Healthcare Experience in Oncology.”

Applications for the 2027 program open Monday, Sept. 28.

The post Move over, Instagram: The screen teens are obsessed with this summer is SHE  appeared first on Vanderbilt Health News.