Overall Program Summary This application for Feasibility and Planning Studies of a P20 Specialized Program of Research Excellence (SPORE) to Investigate Cancer Health Disparities will address racial disparities in metropolitan Detroit, a uniquely important underserved population where great cancer disparities exist. The application includes two scientific projects focused on treatment with immune checkpoint inhibitors (ICIs) now being used in the standard of care setting for lung cancer, an Administrative Core, a Biospecimen Core, a Patient and Community Engagement Core, and a Developmental Research Program. The decision to use ICIs relies heavily on prior treatment response and imperfect tumor biomarkers, and immune-related adverse events (irAEs) dictate continued therapy, and ultimately outcomes, yet little is known about what factors drive disease course in racially diverse populations. The Overall Aim 1 of this Program is to accelerate translational research to reduce health disparities in lung cancer outcomes by: a) characterizing race-specific immune profiles with respect to the tumor environment and host genetic background to determine their contribution to response to ICIs (Project 1); and b) characterizing patient-reported side effects, quality of life, and irAEs in a racially diverse group of lung cancer patients and identifying the individual, behavioral, molecular/genetic and disease-specific determinants of these end points (Project 2). The Overall Aim 2 is to strengthen the existing programmatic structure to encourage translational research into the biology of cancer health disparities, achieve full P50 SPORE funding, and ultimately reduce cancer health disparities by: a) expanding our Cancer Biology of Health Disparities initiative, facilitating use of biospecimens from KCI's racially diverse population, and funding Developmental Research Projects; b) mentoring investigators in cancer health disparities; and c) expanding our community outreach and engagement efforts through a robust Patient and Community Engagement Core (PCEC) to support recruitment and retention of diverse study participants and dissemination of research project progress and findings to participants and lay audiences. This P20 application will enable clinical, basic and population scientists to translate relevant, high-impact scientific discoveries in diverse patients to reduce racial disparities in cancer outcomes, moving towards a more race-inclusive, equity-focused precision medicine approach to cancer treatment and prevention.