‘Multi-pronged approach’ needed to increase diversity in clinical trials
Click Here to Manage Email Alerts
In a special scientific session on race and science at ASH Annual Meeting an Exposition, Saad Z. Usmani, MD, MBA, FACP, FRCP, examined clinical trial inclusion from an investigator’s perspective.
Usmani, a myeloma specialist and cellular therapist at Memorial Sloan Kettering Cancer Center, discussed the need for more representative clinical trial populations, the challenges to trial enrollment and what can be done to achieve more diversity in cancer clinical trials.
“This is going to have to be a partnership with cancer centers and health care institutions, as well as with pharmaceutical partners and patient advocacy organizations,” Usmani said. “There will need to be a partnership across these entities to make these clinical trials more accessible. Of course, we will also need to make sure that the NCI and the regulatory authorities are an integral part of that discussion, too.”
A unique disease biology
Usmani outlined the differences in myeloma disease biology between Black and white patients.
“Myeloma is the second most common blood cancer in the United States, but in the Black population, it is the most common — more common than leukemia or lymphoma,” he said. “We know there is a disparity in its incidence and prevalence.”
Moreover, he said studies have shown that multiple myeloma is diagnosed approximately 4 to 5 years earlier in the general population vs. the Caucasian population. Multiple myeloma in Black patients also tends to present with more aggressive, high-risk features.
Usmani noted that, currently, many clinical trial populations in multiple myeloma studies do not accurately reflect the prevalence of this disease in the Black population.
“Even though one in five myeloma patients is a Black American, only 5% — or one in 20 patients enrolled in clinical trials — is a Black American,” Usmani said.
Addressing concerns, avoiding bias
Usmani discussed some of the major obstacles to multiple myeloma clinical trial enrollment among Black patients and other racial and ethnic minority groups. He noted issues in terms of access to new therapies, access to timely diagnosis and access to hematopoietic stem cell transplantation.
Additionally, concerns or mistrust at the patient level and implicit bias at a care team level pose barriers to diverse clinical trial enrollment.
“What we’ve done over time is to promote clinical trials and break down barriers in terms of educating the primary care networks to recognize and diagnose these patients early,” Usmani said. “It’s also important to dispel any issues or concerns the patients might have.”
At a program level, Usmani emphasized the need to open clinical trials and actively enroll across the health care system, especially at sites that have a higher minority population.
“We also want to make sure that at multidisciplinary meetings, we’re actually talking about the need to ensure we’re having the clinical trial discussion with every patient, not just with patients we perceive to be amenable to such options,” he said. “We want to take away that inherent bias that might be there at the patient care team side of things. It’s a multipronged approach.”
Collapse
Usmani SZ. Race and science: Bench to bedside to the community — clinical trial perspective. Presented at: ASH Annual Meeting and Exposition; Dec. 9-12, 2023; San Diego.
Click Here to Manage Email Alerts