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A recent large-scale study investigated the use of comprehensive genomic profiling and treatment patterns across ancestries to determine their impact on ancestral disparities in advanced prostate cancer. The research provides crucial insights into the genomic landscape and clinical treatment patterns in diverse ancestries, focusing on African and European backgrounds.

  • Advanced prostate cancer genomics and treatment patterns show similarities across ancestries, despite men of African ancestry receiving genomic profiling later in their treatment course.
  • Disparities in clinical trial enrollment post-genomic profiling could potentially affect outcomes and deepen ancestral disparities.
  • Understanding these ancestral disparities can offer new avenues for addressing prostate cancer disparities and improving patient outcomes.

A new study published in The Lancet Digital Health aims to characterize the genomic landscape, comprehensive genomic profiling (CGP) utilization patterns, and treatment patterns across different ancestries in advanced prostate cancer. The study provides a detailed look into the complex landscape of ancestral disparities in prostate cancer treatment and the impact of genomics on these disparities.

Genomic Landscapes Across Ancestries

The study evaluated 11,741 patients with prostate cancer, revealing ancestry-specific mutational landscapes. However, the incidence rates of alterations in the androgen receptor (AR), DNA damage response pathway, and other actionable genes were similar across ancestries. Individuals of African descent underwent more treatment regimens prior to CGP compared to those of European descent.

Treatment Patterns and Clinical Trial Enrollment

Following CGP, individuals of African descent were not as likely to be administered a drug from a clinical trial as their counterparts of European descent. This disparity in clinical trial enrollment could potentially affect the genomic landscape and outcomes and exacerbate disparities in advanced prostate cancer treatment.

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Implications for Clinical Practice

The study findings suggest that disparities in actionable genes might not be a main driver of disparities across ancestries in advanced prostate cancer. The key discrepancies lie in CGP utilization and clinical trial enrollment, particularly among men of African ancestry. These findings highlight the need for equitable access to CGP testing and clinical trial enrollment across different ancestries. For healthcare providers, this underscores the importance of considering a patient’s ancestry in the context of precision medicine and genomic profiling.

Takeaways

The results from this large-scale retrospective analysis provide valuable insights for clinicians. While genomic profiles show similar patterns across ancestries, the timing of CGP utilization and clinical trial enrollment show notable disparities. Clinicians are urged to take these factors into account in their practice and strive for equitable access to genomic testing and clinical trials for all patients, regardless of ancestry. These results provide the foundation for future research to further investigate the complex causes of racial and ancestral disparities in prostate cancer treatment.

Source:

Sivakumar, S., Lee, J. K., Moore, J. A., Hopkins, J., Newberg, J. Y., Madison, R., Graf, R., Schrock, A. B., Kobetz, E., Vince, R., Franco, I., Seldon, C., Frampton, G. M., Mills, J., Venstrom, J., & Mahal, B. A. (2023). Comprehensive genomic profiling and treatment patterns across ancestries in advanced prostate cancer: a large-scale retrospective analysis. The Lancet Digital Health, 5(6), e380–e389. https://doi.org/10.1016/s2589-7500(23)00053-5