Black men less likely to receive targeted therapy for metastatic prostate cancer
Click Here to Manage Email Alerts
Key takeaways:
- Black men more frequently received blood-based molecular testing.
- Despite differences in rates of targeted therapy between the two cohorts, researchers did not notice a difference in clinical outcomes.
Black men with metastatic castration-resistant prostate cancer appear less likely to receive targeted therapies than white men, according to data published in JAMA Network Open.
Despite the contrast, however, researchers observed no difference in clinical outcomes.
“We found no differences between the Black and white cohorts for our primary outcome, the proportion of patients with actionable molecular data; however, [mismatch repair deficiency] or [high microsatellite instability] was more common in Black men,” Clara Hwang, MD, senior staff physician in the Henry Ford Health and clinical assistant professor at Wayne State University School of Medicine, and colleagues, wrote. “Despite this, receipt of immunotherapy in these Black men was approximately 30% lower than for white men, suggesting a barrier by race in the receipt of matched molecular immunotherapy in the U.S.”
Background and methodology
Black men have a higher incidence of and mortality from prostate cancer; therefore, researchers sought to compare precision medicine data and outcomes between Black and white men with metastatic castration-resistant prostate cancer.
Hwang and colleagues conducted a retrospective cohort study using data from the Prostate Cancer Precision Medicine Multi-Institutional Collaborative Effort (PROMISE) consortium, from April 2020 to December 2021.
Of the 962 eligible patients, 204 identified as Black (21.2%; median age, 61 years), of whom 131 (62.4%) had Gleason scores between 8 and 10 and 92 (45.1%) had newly diagnosed metastatic disease.
Of the remaining 758 white patients (78.8%; median age, 63 years), 445 (58.7%) had Gleason scores between 8 and 10 and 310 patients (40.9%) had newly diagnosed metastatic disease.
Frequency of actionable molecular data served as the study’s primary outcome measure. Secondary outcomes included the frequency of other genomic alterations, the type and timing of genomic testing performed and use of targeted therapy.
Results, next steps
Researchers reported median follow-up 26.6 months (interquartile range, 14.2–44.7 months).
Results showed that Black men underwent blood-based molecular testing more frequently than white men (48.7% vs. 36.4%).
Rates of actionable alterations appeared similar between the two groups, with 32.8% of Black men harboring actionable alterations compared with 29.1% of white men. However, mismatch repair deficiency or high microsatellite instability appeared more frequently in Black men than in white men (9.1% vs. 4.9%), while PTEN (15.7% vs. 26.3%) and TMPRSS (7.1% vs. 21%) alterations appeared less frequently in Black men.
Overall, fewer Black men received targeted therapy for metastatic castration-resistant prostate cancer compared with white men (33.5% vs. 53.5%).
Despite the marked difference in targeted therapy rates between the two groups, researchers observed no differences in response to targeted therapy or OS.
“These findings underscore the need for further study for how the environment, social determinants of health, health care infrastructure, practitioner biases and patient behavior interact to produce the cancer disparities and increased prostate cancer mortality that affect Black men,” Hwang and colleagues wrote.
Collapse
Click Here to Manage Email Alerts