Younger Hispanic/Latinx patients face access barriers to CAR-T clinical trials
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Younger Hispanic/Latinx patients face many barriers that may limit timely access to chimeric antigen receptor T-cell therapy trials for relapsed or refractory B-cell acute lymphoblastic leukemia, according to retrospective study results.
The findings — presented at ASH Annual Meeting and Exposition — showed that younger patients referred to urban academic centers for CAR-T clinical trials more often were non-Hispanic/Latinx white, spoke English and typically traveled 40 times farther than locally referred patients.
“CAR T cells have revolutionized the treatment of relapsed B-cell acute lymphoblastic leukemia, but patients can face additional barriers when accessing these therapies,” Anurekha Hall, MD, MS, acting instructor at Seattle Children’s Hospital and the clinical research division at University of Washington and Fred Hutchinson Cancer Research Center, told Healio.
A wealth of information exists regarding racial, ethnic and socioeconomic disparities associated with pediatric clinical trial participation and patient outcomes, but these factors have yet to be evaluated for patients participating in CAR T-cell therapy trials, Hall added.
“Our findings suggest that barriers to access — such as distance and need for travel may differentially impact Hispanic patients,” she told Healio. “Additionally, Spanish-speaking patients and patients with public insurance also were underrepresented in referrals from outside institutions, suggesting that language and insurance may also be key barriers to access.”
Hall and colleagues conducted a multicenter retrospective cohort study of children and young adults with B-cell ALL treated between 2012 and 2018 within the Consortium for Pediatric Cellular Immunotherapy, which includes Seattle Children's Hospital, Children’s National, Children’s Hospital Colorado, Children’s Hospital Los Angeles and UCSF Benioff Children’s Hospitals.
Investigators collected clinical and demographic data from patients’ electronic health records. The researchers also assigned patients a socioeconomic score using U.S. Census data.
The cohort included 1,374 patients aged 27 years or younger with B-cell ALL, 27% of whom had relapsed or refractory disease. The cohort included patients with relapsed or refractory disease who had received a referral to a study center for CAR-T from within (n = 80) or outside (n = 142) the institution, in addition to those with relapsed or refractory disease not referred for CAR-T (n = 150) or local patients without relapsed or refractory disease (n = 1,002).
Patients referred for CAR-T to one of the participating centers traveled a median 824 miles from home to receive their therapy compared with 20.5 miles among local CAR-T recipients.
The group of local CAR-T recipients included a higher percentage of Hispanic/Latinx patients than the group referred from an outside center (56% vs. 29%; P < .01). A higher percentage of patients referred for the therapy than local CAR-T recipients were non-Hispanic/Latinx white (47% vs. 28%; P <.01).
A significantly higher proportion of local CAR-T recipients than referred patients had public insurance (65% vs. 31%; P < .001) and identified Spanish as their primary language (24% vs. 6%; P < .001).
Researchers reported similar mean socioeconomic scores across all patient subgroups. Investigators found this finding “surprising,” according to Hall, given its known association with clinical trial participation and outcomes in other pediatric cancer studies.
Because all CAR-T centers included in the analysis are in urban areas with Hispanic/Latinx populations higher than the national average, local demographics likely had an effect on the ethnic makeup of local CAR-T patients in this study, Hall said.
“However, at the three highest-volume centers, the proportion of Hispanic patients who received local CAR-T appeared greater than the proportion of Hispanic patients in the referred CAR-T cohort, suggesting this may be a more generalized phenomenon,” she added.
The results emphasize the significant obstacles that nonlocal patients face when referred for CAR T-cell therapy and suggest these burdens may disproportionately affect younger Hispanic/Latinx patients located outside urban centers, Hall said.
“Nonlocal CAR-T patients often travel very lengthy distances to access these trials, and this further emphasizes that traveling to trials can place significant burdens on families,” Hall told Healio. “Traveling to receive CAR-T cell therapy can be resource-intensive and not possible for all families. Ultimately, it will be important to provide these life-saving therapies closer to home to allow for more children to have access.”
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Hall AG, et al. Abstract 339. Presented at: ASH Annual Meeting and Exposition; Dec. 11-14, 2021; Atlanta.
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