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Taking on the Lack of Diversity in Cancer Trials

diverse hands in huddle
By John Whyte, MD, MPHJanuary 27, 2020

Although we still have a long way to go in the fight against cancer, over 50 drugs have been approved for cancer in the last three years. That’s good news – until you take a closer look at the data.

In 2018, only 4% of participants were black, and 4% were Hispanic. Another way to think of it: of all the trials for drug approvals, there were less than 450 people of color enrolled.

In 2017, only 2% of participants in cancer drug trials were black, only 4% were Hispanic – again, less than 450 people. In 2015, a trial conducted on a type of breast cancer that disproportionately impacts black women actually had only two black women enrolled. Not two percent – two people!

The statistics from these years are not anomalies – these numbers have been consistently low for decades. And that’s a problem.

Why? Because over the last few years, we have come to recognize that drugs may work differently based on certain factors – particularly sex/gender as well as race/ethnicity. That means that African Americans and/or Hispanics might respond differently to a drug than whites. We’ve seen this in numerous drugs, such as certain medicine for high blood pressure and heart failure. That can ultimately impact dosing, as well as side effects – but if we don’t study a diverse trial population, how will we know? 

Thankfully, organizations are beginning to address this issue in a more meaningful way than in the past. The FDA recently announced a new focus on enhancing clinical trial diversity. That’s a step in the right direction. In addition, Stand Up To Cancer has recognized that this lack of diversity can lead to inequity, so they have launched has a new initiative to improve health equity in cancer clinical trials. They will now require that all grant proposals address how the research will consider ethnic diversity, and recruit and retain diverse patients in its clinical trials. This operational process institutionalizes diversity in clinical trials into the Stand Up to Cancer selection process and into the semi-annual performance reviews conducted for all active grants. This is a big deal since it will hold researchers accountable – something that hasn’t been done before. We also will be able to learn best practices so others can also make changes to develop a clinical trial population that looks more like society.

What can you do? Don’t assume that if you are eligible for a trial, someone will invite you to participate – because that’s not true for everyone. If you have cancer, ask your doctor about whether you could participate in a clinical trial? Call your local cancer center and ask them about current clinical trials.  Search online at sites like clinicaltrials.gov (honestly, it’s not the most user-friendly but it’s a good start).  And if you are asked to participate in a trial, make sure you know exactly what is required of you, and weigh the options carefully with your family and your physician.

Editor's note: John Whyte is a member of the SU2C Committee for Health Equity in Cancer Clinical Trials.

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