Exploring Underrepresentation in Clinical Trials of Prostate Cancer

Smruthy Sivakumar, PhD, a scientist at Foundation Medicine, discusses a large-scale analysis of comprehensive genomic profiling utilization and ancestral characterization of the genomic landscape in patients with advanced prostate cancer.

There are multiple reasons for underrepresentation in clinical trials, according to Sivakumar. She says that men with African ancestry are one of the more underrepresented groups in clinical trials of genomic testing and precision medicine. There are options for reducing this disparity to ensure that clinical trials are as diverse as possible, such as providing education and access.

Transcription:

0:08 | Prostate cancer incidence mortality as well as outcomes vary widely across race and ancestry. The underlying drivers for these differences are multifactorial, so there's an interplay of biology, socioeconomic factors, and environmental exposures. Particularly men of African ancestry have been shown to have a higher burden of the disease and are particularly underrepresented in genomic and precision medicine studies. This has led to a limited understanding of disparities in prostate cancer in general. There have been a few previous studies that have looked into it in smaller cohorts of metastatic prostate cancers, but the results have been mixed and they've mostly been limited by cohort size. So, with the shared passion for this research, we put together a cross-functional team at Foundation Medicine as well as University of Miami Sylvester Cancer Center to look into different aspects of comprehensive genomic profiling in addressing prostate cancer disparities.

1:25 | I think, mostly, what is required right now is to ensure that there is an equitable use of comprehensive genomic profiling testing, which I think would be extremely valuable in terms of reducing disparities overall. So equitable use of CTP [Comprehensive Program Testing], clinical trial enrollment, as well as subsequent precision medicine initiatives. There's a necessity to enroll people from a very diverse population moving forward to make sure that we're trying to reduce this gap as much as possible.

2:11 | We did not see a difference in the rate of gene alterations based on ancestry. This likely suggests that intrinsic biological differences may be unlikely to be a major driver of ancestry-based disparities, particularly in men who have advanced prostate cancer. However, we did notice that African men were less likely to receive comprehensive genomic profiling earlier in their treatment course and less likely to be treated on clinical trials. This could itself have a huge impact on genomic landscape outcomes and, ultimately, disparities. Progress requires commitment and education; I think primarily education to make sure that more people have access to comprehensive genomic profiling, as well as advanced treatment options and high-quality cancer care to better inform personalized, targeted treatment decisions.