Multiple Myeloma Status Quo
Over 30,000 Americans are diagnosed with multiple myeloma each year. And more than 12,500 Americans pass away due to multiple myeloma annually.
Multiple myeloma is a cancer of plasma cells. With multiple myeloma, the bone marrow consists of excess plasma cells associated with monoclonal protein in the blood and/or urine. Clinical complications include hypercalcemia, renal dysfunction, anemia, bone disease, increased risk of infection, and neuropathy.
Clinical trial advancements have led to remarkable treatment options, including:
- High-dose therapy
- Autologous stem cell transplantation
- Immunomodulatory drugs
- Proteasome inhibitors
- Monoclonal antibodies
- Histone deacetylase inhibitor
- Nuclear transport inhibitor
- Antibody–drug conjugate
The development of more therapies will enable further improved patient outcomes.
Yet, research studies suggest that although African Americans are at a higher risk of multiple myeloma, they are underrepresented in clinical trials. As a result, they reap fewer benefits from novel multiple myeloma therapies. In fact, between 1973 and 2005, white Americans diagnosed with multiple myeloma experienced an increased survival rate of 26.3% to 35.0% (P < 0.005), while African Americans experienced an increased survival rate of 31.0% to 34.1%.
A Step Toward Achieving Healthcare Equity
The U.S. Food and Drug Administration collaborated with the American Association for Cancer Research (AACR) to conduct the Workshop to Examine Under-representation of African Americans in Multiple Myeloma Clinical Trials. The collaboration analyzed and provided recommendations about these discrepancies. Researchers, physicians, patients, statisticians, and regulators analyzed the relationship of factors such as genetics and biology with underlying racial and ethnic differences, trial enrollment characteristics, and outcomes among multiple myeloma patients.
Gormley et al. (2021) analyzed and furthered these recommendations to eliminate racial disparities among multiple myeloma patients. The principles outlined offer a roadmap to address inequities and achieve equity in healthcare. The guidance can lead to a more inclusive, “real-world” drug development paradigm.
Recommendations to Eliminate Racial Disparities in Multiple Myeloma Therapies
It is essential to disseminate education widely through various mediums to educate patients and advocates. Tailor patient education to their education level, understanding of the medical process, engagement appetite, and engagement ability.
In addition, diversity officers are crucial to:
- Define strategies that support diverse participation in clinical trials
- Interrupt personal and systematic biases
- Identify and understand regional differences and barriers for enrollment
- Implement policy and procedure best practices
There is also a need to promote diversity among the clinical trial research and the patient population they serve. Collaborate with relevant stakeholders to identify and implement feasible and effective interventions to enroll and retain participation. And establish goals that are representative of the disease epidemiology.
The publication’s recommendations can be generalized or applied to various population groups and diseases. As a result, we can achieve improved diverse representation and better understand how drugs will perform among patient populations.
Gormley, N., Fashoyin-Aje, L., Locke, T., Uniger, J.M., Little, R.F., Nooka, A., Mezzi, K., Popa-McKiver, M., Kobos, R., Biru, Y., Williams, T.H., Anderson, K.C. (2021). Recommendations on eliminating racial disparities in multiple myeloma therapies: A step toward achieving equity in healthcare. Blood Cancer Discovery. 2(2), 119-124. https://doi.org/10.1158/2643-3230.BCD-20-0123