Investigators may have uncovered key differences in tumor biology but similarities in survival outcomes in instances of equal access to care between non-Hispanic Black and non-Hispanic White men with metastatic prostate cancer, according to a recent study published by Valle et al in JAMA Network Open.
Study Methods and Results
In a clinical genomic profiling study, the investigators analyzed the data of more than 5,000 U.S. veterans with metastatic prostate cancer who underwent next-generation sequencing between 2019 and 2023.
The investigators discovered that despite higher rates of actionable immunotherapy targets among the non-Hispanic Black patients, the non-Hispanic White patients had more frequent alterations in androgen receptor signaling and DNA repair pathways. For instance, the non-Hispanic Black patients were more likely to have genomic alterations associated with immunotherapy benefit such as microsatellite instability, whereas the non-Hispanic White patients had higher rates of mutations in DNA repair genes and the androgen receptor axis—which may influence responsiveness to hormonal therapies.
Regardless of these biological differences, the survival outcomes were comparable in the equal-access Veterans Affairs (VA) setting. Further, tumor suppressor gene alterations were linked to poorer survival in both patient groups. The investigators noted that no biomarkers that should be excluded from testing based on race were found.
Conclusions
“These results affirm that precision oncology can be a powerful tool for achieving equitable cancer care,” highlighted co–senior study author Kosj Yamoah, MD, PhD, Chair of the Radiation Oncology Program at the Moffitt Cancer Center. “By using genomic testing to guide therapy selection, we can match patients to treatments based on their tumor biology, not race,” he emphasized.
“This research reinforces that we must not let historical disparities define modern care. Instead, by prioritizing access to genomic tools, we can drive meaningful change in how prostate cancer is treated across all populations,” added co–senior study author Isla Garraway, MD, PhD, Director of Research in the Urology Department at the University of California, Los Angeles Health.
The investigators indicated that their study’s diverse cohort—consisting of 36% non-Hispanic Black patients—represented a notable improvement in inclusion compared with previous genomic studies. However, they underscored the significance of continuing to broaden access to next-generation sequencing and ensuring that underrepresented patient groups are included in precision oncology research and clinical trials.
“This study shows that when we remove barriers to care and apply precision medicine equitably, we can improve outcomes for all patients,” concluded co–senior study author Kara Maxwell, MD, PhD, Assistant Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania.
Disclosure: The research in this study was supported by the National Cancer Institute, the Prostate Cancer Foundation, and the VA National Precision Oncology Program. For full disclosures of the study authors, visit jamanetwork.com.
