Racial Disparities in Oncology Clinical Trials

A new study in JAMA Oncology reports the existence of racial disparities in clinical trials leading to cancer drug approvals from 2008-2018. The authors state that blacks (22% of expected proportion) and Hispanics (44% of expected proportion) were underrepresented in these trials relative to their proportion among the US cancer population.

Figure 1, Part C: The absolute number of patients of races other than white who participated in pivotal trials leading to FDA approval was considerably low. From: Loree JM, Anand S, Dasari A, et al. Disparity of Race Reporting and Representation in Clinical Trials Leading to Cancer Drug Approvals From 2008 to 2018. JAMA Oncol. Published online August 15, 2019. doi:10.1001/jamaoncol.2019.1870

Back in 2004, a study published in JAMA indicated that racial and ethnic minorities, women, and the elderly were less likely to enroll in cooperative group cancer clinical trials than were whites, men, and younger patients, respectively. A more recent ProPublica examination showed that black people and Native Americans are under-represented in clinical trials of new drugs, even when the treatment is aimed at a type of cancer that disproportionately affects them.

Dr. Mona Fouad suggests that one possible strategy to increase minority participation in clinical trials may be patient navigators. A 2016 study she co-authored on patient navigation demonstrated that the patient navigation model “holds promise as a strategy to reduce disparities in cancer clinical trial participation” and that “future studies should evaluate it with racial/ethnic minorities across cancer centers.”

Predicting Immunotherapy Response, Cancer Relapse and More

  • The researchers at Fred Hutchinson Cancer Research Center discovered that cancer cells express DUX4, a gene responsible for certain muscular dystrophies, to protect themselves from the effects of immunotherapy, in particular – from immune checkpoint inhibitors. The implications of this research would be development of therapies that would target DUX4 and thus make treatment with immune checkpoint inhibitors more efficient. The study is due to be published in Developmental Cell.
  • Researchers from the University of Western Australia in collaboration with Telethon Kids Institute and 13 health research organizations looked into the genes in cancer samples and devised a way of using cancer samples to identify potential response to immune checkpoint inhibitors therapy before initiating immunotherapy treatment. This could help identify drugs that improve response to checkpoint inhibitors. The study was published in Science Translational Medicine.
  • Researchers from the City of Hope Comprehensive Cancer Center have come close to developing a blood test, based on a patient’s immune response, which may predict relapse of breast cancer. The study was published in Nature Immunology.
  • It is known that cancer cells spread in the body by feeding on sugar. British researchers discovered that if deprived of sugar, cancer cells switch, with the help of a protein called AKR1B10, to fatty acids as a source of energy to boost their spread. The implications could be for diagnosis, as increased levels AKR1B10 may predict metastatic spread; and for management, which means development of new treatments that would prevent cancer cells from using fatty acids. This preclinical study was published in Nature Communications.

Chronic Pain in Cancer Survivors: A Closer Look at Prevalence

A new research study published in JAMA Oncology has found that about 35% of cancer survivors live with chronic pain. One of the study’s authors is Dr. Robert Sidlow, MD, MBA, Head, Division of Survivorship and Supportive Care; Associate Chair, Patient Care Operations at MSK.

Dr. Robert Sidlow Image credit: MSK Digital Assets Library

Corresponding author Changchuan Jiang, MD, MPH, a medical resident at Mount Sinai St. Luke’s and Mount Sinai West, told Science Daily that the study is the “first comprehensive estimate of chronic pain prevalence among cancer survivors” and that the study results “highlight the important unmet needs of pain management in the large, and growing cancer survivorship community.”

The study also found that the prevalence of chronic pain is highest among certain types of cancer survivors – including bone (54.0%), kidney (52.3%), throat-pharynx (47.9%), and uterine (44.5%) cancers.

Jiang, C., Wang, H., Wang, Q., Luo, Y., Sidlow, R., & Han, X. (2019). Prevalence of Chronic Pain and High-Impact Chronic Pain in Cancer Survivors in the United States. JAMA oncology.