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Racial disparities in health outcomes, including cancer, are well documented. However, it is not always clear how biological or socio-economic factors affect these disparities, or whether advances in genomics and precision medicine are having an impact.
Today, new research presented at the 2021 annual meeting of the American Society of Clinical Oncology (ASCO) paints a clearer picture of what determines the differences in mortality and outcomes in cancer patients. the prostate, which has a higher incidence and mortality in black men.
The lifetime probability of developing prostate cancer is 18.2% in black men compared to 13.3% in white men. Black men are also significantly more likely to die from prostate cancer than white men (4.4% vs. 2.4%). 1
While advances in genomics and precision medicine promise to improve risk prediction and outcome for many cancers, they can actually exacerbate these disparities. In a study presented in summary form by Foundation Medicine and coworkers, Brandon Mahal, MD, assistant professor of radiation oncology and assistant director of community outreach and engagement at the Sylvester Comprehensive Cancer Center, and researchers looked at how models of complete genomic profiling and treatment varied by race.2
The data, from the largest known cohort of this type, revealed that despite a similar frequency of exploitable genetic alterations, men of African descent were less likely than men of European descent to receive early full genomic profiling. and be enrolled in clinical trials.
The researchers collected data on more than 11,000 patients with advanced prostate cancer with full genomic profiling, including 1,400 men of African descent and 9,200 patients of European descent. They also analyzed real-world data from nearly 900 patients from Foundation Medicine and Flatiron Health’s Clinical Genomics Database.
The modification rates of BRCA1 / 2, WITH, DNA damage response pathway genes and actionable genes were similar for both ancestry types. And while both groups were equally likely to receive immunotherapy and PARP inhibitor therapy, men of African descent were almost 3 times less likely to receive investigational treatment in a clinical trial than men of ancestry. European (11% against 30%). This held true even among men with workable alterations (1% vs. 6%).
“Men of African descent bear the greatest burden of disease from prostate cancer, and this research indicates that the differences in cancer care are not based solely on biological factors, but rather on socio-social factors. -economic such as access to full genomic profiling and clinical trial enrollment, “Mahal said in a statement.3” To ensure equitable opportunities for precision medicine, we need to expand access and awareness of advancements that impact patient care and outcomes, including the timely use of genomic testing to help make informed treatment decisions. “
During a separate presentation, Mahal explained that most genomic studies are based on Eurocentric cohorts, with around 80% of the patients included in the Genome Association Study (GWAS) being of well European descent. that they represent 16% of the population, leaving the door open to worsening disparities due to a lack of representative studies.4
Mahal described several approaches that could be taken to study and treat disparities in prostate cancer, including:
- Transdisciplinary research that links basic, clinical and epidemiological research
- Trials that include diverse populations
- Precision medicine used as a means of identifying mechanisms of disparity
- Outreach program to bring advanced healthcare and science to diverse communities.
The references
1. Cancer Facts and Figures for African Americans 2016-2018. American Cancer Society website. Accessed June 18, 2021. https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html
2. Sivakumar S, Lee J, Moore J, et al. Ancestral characterization of the genomic landscape, full genomic prostate cancer: a large-scale analysis. J Clin Oncol. 2021; 39 (Suppl 15): abstr 5003. doi: 10.1200 / JCO.2021.39.15_suppl.5003
3. New study results presented by Foundation Medicine and collaborators at ASCO21 on cancer care underscore the importance of equitable access to advances in precision medicine. Press release. Medicine foundation; June 4, 2021. Accessed June 6, 2021. https://www.foundationmedicine.com/press-releases/aa904bd1-4854-44e9-8d03-24b5af5ff392.
4. Martin AR, Kanai M, Kamatani Y, et al. Clinical use of current polygenic risk scores may exacerbate health disparities. Nat Gen. 2019; 51 (4): 584-591.
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