Simply having access to clinical trials does not ensure equitable outcomes by race and ethnicity, a new study suggests.
The study showed that Hispanic children with previously untreated, high-risk neuroblastoma have inferior overall survival (OS) when compared with their non-Hispanic White peers, even when both groups receive the same treatment and after controlling for other confounding factors.
These findings are scheduled to be presented at the 2022 ASCO Annual Meeting and were disclosed in a press briefing in advance of the meeting.
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The study included data from 3 Children’s Oncology Group trials testing upfront treatments in children with high-risk neuroblastoma (ANBL0532, ANBL09P1, and ANBL12P1).
The study included 696 patients. Most (69%) were non-Hispanic White, 16% were non-Hispanic Black, 11% were Hispanic, and 4% were categorized as “other non-Hispanic.” One-third of patients (33%) were exposed to household poverty, 26% were exposed to area-level poverty, and 15% lived in rural areas.
There were no significant differences in tumor stage and biology across the race/ethnicity categories or the poverty categories.
The researchers found that 5-year OS was inferior for children with household poverty (63% vs 53%; P =.04) or neighborhood poverty (62% vs 54%; P =.05), when compared with children not exposed to either type of poverty.
However, the poverty exposures were not significantly associated with OS after the researchers adjusted for other factors. Likewise, there was no significant difference in OS when comparing patients from rural and non-rural areas, in adjusted or unadjusted analyses.
The researchers did find that 5-year OS differed significantly by race/ethnicity in unadjusted and adjusted analyses.
The 5-year OS was 47% for Hispanic patients, 50% for other non-Hispanic patients, 61% for non-Hispanic White patients, and 63% for non-Hispanic Black patients (P =.047).
In a multivariable analysis, the hazard ratio (HR) for death was 1.78 for Hispanic patients and 1.45 for other non-Hispanic patients, compared with non-Hispanic White patients (P =.01). The HR for non-Hispanic Black patients was 0.98.
“[O]ur data show that Hispanic children with high-risk neuroblastoma have inferior overall survival compared to other children, and this is despite having access to the same clinical trials and receiving the same uniform planned treatment and after controlling for disease-associated factors,” said lead study author Puja J. Umaretiya, MD, of Dana-Farber Cancer Institute and Boston Children’s Hospital.
“We acknowledge that describing disparities is simply not enough,” she added. “We must strive to identify mechanisms that cause inequitable outcomes.”
Dr Umaretiya noted that the OS difference in this study was not caused by treatment delays, stopping the trial early, or increased relapse rates, as these outcomes did not differ significantly by race/ethnicity.
With future research, Dr Umaretiya and colleagues plan to evaluate the interaction between race, ethnicity, and poverty as well as examine the post-relapse period to explore enrollment on early phase trials and causes of death.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Umaretiya PJ, Naranjo A, Zhang F, et al. Racial, ethnic, and socioeconomic survival disparities among children with high-risk neuroblastoma treated on upfront Children’s Oncology Group clinical trials. To be presented at ASCO 2022; June 3-7, 2022. Abstract 10005.
