‘Equitable access’ to care may reduce racial disparities in prostate cancer survival
Key takeaways:
- Black men with prostate cancer achieved similar PFS and OS as white men when treated in a clinical trial setting.
- Equitable access to care may reduce disparities in survival among Black men.
Black men with metastatic castration-sensitive prostate cancer achieved OS and PFS comparable to white men when treated in a clinical trial setting, according to results of the randomized phase 3 SWOG 1216 trial.
The findings — published in JAMA Network Open — suggest equal access to health care resources, such as those provided in a clinical trial setting, can help alleviate racial disparities in survival among Black men with advanced prostate cancer, researchers concluded.
“If Black patients receive similar treatments, then their outcomes are similar to white patients,” investigator Neeraj Agarwal, MD, FASCO, professor of medicine and presidential endowed chair of cancer research at University of Utah’s Huntsman Cancer Institute, told Healio. “The dogmatic view of linking more aggressive disease in Black patients with poorer outcomes may not be correct.”
Background
Black men with prostate cancer have had “suboptimal representation” in clinical trials, Agarwal said. Black patients typically account for 1% to 3% of randomized trial participants, even though they account for approximately 10% of the nation’s population.
“The last few years have seen an increased emphasis on equitable accrual, because we need to know how drugs work in minority patient populations,” Agarwal said.
Beyond knowing when agents may have variable effects across race or ethnicity, having this large sample of data based on race allowed researchers to compare outcomes in a multiregional, multicenter clinical trial setting where “fair and equitable care” had been provided, he added.
Results from a previous phase 2 study of patients with metastatic castration-resistant prostate cancer showed equitable access to care in a clinical trial setting reduced survival disparities typically observed when comparing groups according to race.
“We wanted to answer this question: Are poor outcomes [among] Black patients because of aggressive disease biology or due to a lack of access [to care]?” Agarwal said.
Methodology
Agarwal and colleagues conducted a secondary analysis of the randomized phase 3 SWOG 1216 trial to compare differences in survival outcomes by race among men with metastatic castration-sensitive prostate cancer.
The investigators chose the SWOG 1216 study for the analysis because it included a high proportion (10%) of self-reported Black patients as enrollees.
Researchers conducted a secondary analysis of the trial’s patient-level data that included participants with newly diagnosed metastatic castration-sensitive prostate cancer who enrolled in the study between March 1, 2013, and July 17, 2017.
The analysis included 1,313 men (135 Black [median age, 65.8 years; interquartile range, 60.1-70.4] and 1,077 white [median age, 68.4 years; interquartile range, 62.5-74.1]) who had received androgen deprivation therapy. The men had been randomly assigned 1:1 to additional treatment with 300 mg orteronel twice daily or 50 mg bicalutamide daily.
OS served as the primary endpoint. PFS and PSA response rate at 7 months served as secondary endpoints.
Key findings
After median follow-up of 4.9 years, results showed Black men and white men achieved comparable median PFS (2.3 years vs. 2.9 years) and OS (5.5 years vs. 6.3 years).
The survival outcomes remained consistent in multivariable analysis adjusted for treatment group, extent of disease, Gleason score, age and baseline PSA.
Researchers also reported similar PSA response rates between Black men and white men at 7 months (55.8% vs. 62.8%) and 16 months (14.2% vs. 10.6%).
Clinical implications
Despite known differences in disease biology that may have an effect on treatment, the results of this study suggest that if Black men with advanced prostate cancer receive equitable care, they can achieve outcomes similar to those achieved by white men, Agarwal said.
“Black patients had equally good outcomes when provided with similar treatment,” Agarwal told Healio. “The message from these results is we should try our best to provide equitable access to care to all parts of society to achieve similar outcomes for all.”
For more information:
Neeraj Agarwal, MD, FASCO, can be reached at Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Suite 5510, Salt Lake City, UT 84112; email: neeraj.agarwal@hci.utah.edu.
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