Both Black and White patients with metastatic castration-sensitive prostate cancer (mCSPC) showed similar progression-free survival (PFS) and overall survival (OS) in a clinical trial setting, according to findings from a secondary analysis of a randomized clinical trial.
With prostate cancer (PC), Black patients manifest more aggressive disease and have higher mortality than White patients with PC, explained Nicolas Sayegh, MD, the lead author of a study published in JAMA Network Open. “Race and social determinants of health influence [PC]-specific mortality and OS; however, in a previous trial, Black patients did not have inferior outcomes compared with White patients, possibly because of equitable access to care available in a clinical trial setting,” Dr. Sayegh and colleagues wrote.
Researchers Observed No Interaction Between Race and Treatment
To compare survival outcome differences in patients with mCSPC by race, the researchers conducted a multicenter, randomized, open-label, phase 3 study that examined androgen deprivation therapy (ADT) with first- or second-generation androgen receptor pathway inhibitors. OS was the main outcome of the study, with PFS as a secondary endpoint.
The study comprised 10% Black patients and 82% White patients. Between both groups, there was equal racial distribution. Compared with other phase 3 trials in this setting, this trial enrolled the highest proportion of Black patients with mCSPC to date, according to the study authors.
Black patients in the study were younger than their White counterparts (median [IQR] age, 65.8 [60-70] vs 68.4 [62.5-74.1]; P=0.001). Additionally, compared with White patients, Black patients had a higher median (IQR) baseline prostate-specific antigen response rate (54.7 [19.8-222.0] vs 26.7 [9.2-96.0] ng/mL; P< 0.001).
At a median follow-up of nearly 5 years, the study team found that both groups had similar median PFS (2.3 years (95% CI, 1.8-1.4 years) vs 2.9 years (95% CI, 2.5-3.3 years); P=0.71) and OS (5.5 years (95% CI, 4.8-no response_ vs 6.3 years (95% CI, 5.7-no response); P=0.65). After adjusting for known prognostic factors, the multivariable analysis confirmed similar PFS and OS. The researchers observed no interaction between race and treatment.
Addressing Variables Linked With Social Determinants of Health
These findings revealed that Black patients with advanced PC achieve similar outcomes when treatment is standardized and access to healthcare is equalized.
“When social determinants of health such as age, comorbidities, insurance status, income status, extent of disease, geography, standardized treatment, and equitable and harmonized insurance benefits were accounted for, there was no difference in [PC]-specific mortality or OS between Black and White patients across all disease stages,” Dr. Sayegh and colleagues wrote.
Future courses of action, they added, should include addressing variables linked with social determinants of health in research and challenging modifiable economic, cultural, and geographic issues in clinical settings.
