Research Discovers Genomics, Precision Medicine May Exacerbate Prostate Cancer Racial Disparity

Racial disparities in health outcomes, including cancer, are well documented. However, it is not always clear how biological or socio-economic factors affect these disparities, or whether advances in genomics and precision medicine will affect them.

A new study, now presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, finds more factors driving the difference in mortality and outcome in prostate cancer patients with high incidence and mortality in black men. It is clearly shown.

The lifetime probability of developing prostate cancer is 13.3% for white men and 18.2% for black men. Black men are also significantly more likely to die of prostate cancer than white men (4.4% vs. 2.4%) 1.

Advances in genomics and precision medicine promise to improve risk predictions and outcomes for many cancers, but they can actually exacerbate these disparities. The study, presented as a summary by Foundation Medicine and collaborators, includes Dr. Brandon Mahal, MD, and researchers, assistant professor of radiation oncology and assistant director of community outreach and engagement at the Sylvester Center for Comprehensive Cancer. We investigated various patterns of genome profiling and treatment. It depends on the race. 2

Data from the largest known cohort of this species show that African men are earlier than European men in comprehensive genomic profiling, despite similar frequencies of viable genetic alterations. It was revealed that it is unlikely to be enrolled in clinical trials.

The researchers collected data on more than 11,000 patients with advanced prostate cancer using comprehensive genomic profiling, including 1400 males of African descent and 9200 patients of European descent. .. They also analyzed real-world data from approximately 900 patients from the Foundation Medicine and Flatiron Health clinic genome databases.

Rate of change BRCA1 / 2, When, DNA damage response pathway genes, and viable genes were similar between the two ancestral types. And while both groups were equally likely to receive immunotherapy and PARP inhibitor treatment, African men were nearly three more likely to receive clinical trial treatment in clinical trials than European men. It was one-third (11% vs. 30%). This was also true among men with viable changes (1% vs. 6%).

“African men are experiencing the greatest burden of prostate cancer disease. In this study, differences in cancer treatment are not based solely on biological factors, but comprehensive genomic profiling and clinical trials. It shows that it indicates socio-economic factors such as access to study registration. Mahal said in a statement. 3 “Informed treatment to ensure a fair opportunity for precision care. There is a need to increase access and awareness of advances that affect patient care and outcomes, such as the timely use of genomic testing to make decisions. “

In another presentation, Mahal said that most genome studies are based on the Eurocentric cohort, even though about 80% of patients in a genome-wide association study (GWAS) make up 16% of the population. I explained that it was of European descent. The lack of representative studies can exacerbate inequality.

Mahal outlined several approaches that can be used to both study and address prostate cancer inequality, including:

• Interdisciplinary research that connects basic research, clinical research, and epidemiological research
• Trials involving diverse populations
• Precision medicine used as a means of identifying the mechanism of inequality
• An outreach program to bring care delivery and cutting-edge science to diverse communities.

References

1. African American Cancer Facts and Numbers for 2016-2018. The website of the American Cancer Society. Accessed on June 18, 2021. https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

2. Sivakumar S, Lee J, Moore J, other genomic landscapes, comprehensive genomic ancestral characterization of prostate cancer: large-scale analysis. J Clin Oncol.. 2021; 39 (Suppl 15): abstr 5003. Doi: 10.1200 / JCO.2021.39.15_suppl.5003

3. New findings on cancer treatment published by collaborators of Foundation Medicine and ASCO21 underscore the importance of equitable access to advances in precision medicine. news release. Basic Medicine; June 4, 2021. Accessed on June 6, 2021. https://www.foundationmedicine.com/press-releases/aa904bd1-4854-44e9-8d03-24b5af5ff392..

4. Martin AR, Kanai M, Kamatani Y, etc. Clinical use of current polygene risk scores can exacerbate health inequalities. Natgen.. 2019; 51 (4): 584-591.