BIPOC involvement in oncological research: insights from Future Oncology
In this special edition of editor’s highlights, Michael Bell, Managing Editor at Taylor & Francis Group, looks at three articles published over the last 12 months in Future Oncology, concerning greater engagement and representation for Black, Indigenous and People of Colour (BIPOC) people in oncological research.
Efficacy and safety of Darolutamide in Black/African-American patients from Phase III ARAMIS study
Nubeqa® (darolutamide) is a potent and selective androgen receptor inhibitor (ARi), which is used as a treatment option for patients with prostate cancer that has stopped responding to androgen deprivation therapy (ADT) but has not metastasized to other parts of the body. This is known as nonmetastatic castration-resistant prostate cancer (nmCRPC).
In the United States, the incidence of prostate cancer (PC) is higher for Black and African-American people than for other racial and ethnic groups. Moreover, mortality rates amongst Black and African-American prostate cancer patients are considerably higher than mortality rates for White and Hispanic patients.
This disparity has been attributed to many biological causes, including hormone levels, genetic alterations and diet. Black/African American patients are typically diagnosed with PC at a younger age than other ethnic groups and are more likely to have higher protein-specific antigen (PSA) levels and more aggressive forms of the disease. The latter being caused by a higher frequency of mutations linked to PC. These risk factors are exacerbated by Black/African-American patients being less likely to receive treatment and left waiting longer for primary treatment than White patients.
In a Phase III double-blind global clinical trial, 52 Black/African-American patients, all suffering from nmCRPC were divided in a 2:1 ratio between darolutamideand placebo. The placebo was treated in conjunction with ADT. Results of the trial showed that darolutamide increased metastasis-free survival time by nearly 2 years. Moreover, survival rates also increased in the darolutamide group, with 3-year survival rates at 100% (compared to 71% for the placebo group).
View the full journal article here
Read the journal article and plain language summary, plus gain a visual snapshot of the trial through the graphical abstract and animated video.
A plain language summary of daratumumab plus lenalidomide/bortezomib/dexamethasone in transplant-eligible Black patients with newly diagnosed multiple myeloma in the GRIFFIN study
In a plain language summary of their research article published in Blood Cancer Journal in 2022, Nooka et al. provide a digestible explanation of the core findings of their paper. The Phase III GRIFFIN study involved 207 patients diagnosed with multiple myeloma (MM). The purpose of the paper was to address systemic issues in literature, with ethnic minorities being historically underrepresented in clinical trials.
The study tested the monoclonal antibody Darzalex® (daratumumab) as a treatment for MM and its efficacy in non-white demographics. Results demonstrated that Black patients treated with daratumumab, taken in conjunction with chemotherapy, presented a greater reduction in cancer cells when compared to patients receiving chemotherapy (lenalidomide, bortezomib and dexamethasone) alone. Moreover, it highlighted no difference in the efficacy of daratumumab combination therapy between racial demographics. Daratumumab also demonstrated similar safety profiles to chemotherapy alone. Safety results were generally similar for Black and White participants of the study.
View the full Plain Language Summary here
Read the full plain language summary of publication for the GRIFFIN study.
BIPOC experiences of (anti-)racist patient engagement in adolescent and young adult oncology research: an electronic Delphi study
In 2022, over 87,000 of the 1.9 million new cancer cases in the US were patients in the adolescent and young adult (AYA) demographic (15−39 years). This age demographic has a poorer outlook than both pediatric and older adult cancer patients, seeing surprising differences in diagnoses, survival rates and access to treatment. AYAs are also more likely to come into financial hardship as a result of cancer diagnosis. Intersectional analysis shows that AYAs who are BIPOC are particularly vulnerable to inequities in healthcare after a cancer diagnosis.
Structural racism not only inhibits BIPOC access into the medical field but also changes how medicine engages with the community. Marginalized groups have historically found themselves shut out at every stage of the conversation, including representation at clinical trials.
BIPOC AYAs have seen increasing demands to engage in research and patient advocacy initiatives throughout medicine. However, this initiative has been led primarily by White-led organizations, blinkered by their own experience. In order to reach equity in healthcare, it is paramount that BIPOC AYA voices are heard to deconstruct systemic barriers to health equity.
In this research article by Cheung et al. building on previous research by the team, an expert panel of BIPOC AYA cancer patients participated in an electronic study to identify strategies for antiracist patient engagement. The Delphi-study was a three-stage online study, aimed at ascertaining what motivated BIPOC AYAs to participate in oncology research, as well as the reasons why they do not participate.
The survey identified the importance of strong communication to inspire participation by educating on the impact of research on the lives of BIPOC AYA cancer patients, demonstrating the relevance to the community of participating in advocacy and research. The lack of genuine representation was found to be a major factor in BIPOC AYA nonparticipation. Opaque research and a lack of diversity among researchers and leadership were identified as causes for a lack of engagement in BIPOC AYA patients. A central result of the study was the importance of transparency, honesty and trust between patients and caregivers, researchers and leadership.
Read the full Research article published in Future Oncology here, including a full description of the Delphi method.