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Globalization of cancer clinical trials linked to lower enrollment of Black patients

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For the drug approval process in the United States, investigators have been expanding clinical trials to sites outside the country. However, a new study indicates that this trend may be widening racial disparities in patient enrollment in cancer clinical trials. The study is published by Wiley early online in CANCER, a peer-reviewed journal of the American Cancer Society.

Without adequate representation in clinical trials, it is difficult to assess whether a medication will be safe and effective for all populations. Unfortunately, Black individuals have historically been poorly represented in clinical trials of anticancer medications, and their inclusion has been decreasing in recent years. Globalization of cancer clinical trial enrollment may play a role in this trend: to reduce costs and expedite patient enrollment, trials have increasingly enlisted clinical sites outside the United States.

To investigate the issue, a team led by Matthew Galsky, MD and Serena Tharakan, BS, of the Icahn School of Medicine at Mount Sinai in New York City, analyzed demographic information from 21 cancer clinical trials leading to U.S. Food and Drug Administration approvals between 2015 and 2018.

The team found that clinical trials conducted primarily outside the United States were significantly less likely to enroll Black participants than U.S. clinical trials–on average, global trials enrolled less than half the proportion of Black patients than trials conducted primarily within the country. Of the 21 clinical trials supporting 18 FDA drug approvals where race and location data were available, 64 percent of patients were enrolled outside the United States, with Black patients accounting for only an average of 3.2 percent of enrollment.

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“There have been a number of studies investigating factors such as access to healthcare, physician biases, and socioeconomic status that may lead to underrepresentation of Black patients,” said Tharakan. “However, to our knowledge, our findings are the first to quantitatively demonstrate that the globalization of cancer clinical trials may also be a key driver of racial disparities in the U.S. drug approval process.”

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The study’s investigators hope that their results may help to inform policies focused on addressing racial disparities in cancer research and care.

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Additional Information


NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the Cancer News Room upon online publication. For more information or to obtain a PDF of any study, please contact:

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Full Citation: “The impact of globalization of cancer clinical trials on enrollment of Black patients.” Serena Tharakan, Xiaobo Zhong, and Matthew D. Galsky. CANCER; Published Online: March 8, 2021 (DOI: 10.1002/cncr.33463).

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.33463

Author Contact: Marlene Naanes, of the Mount Sinai press office, at [email protected]

About the Journal

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online.

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About Wiley

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