by Frances Gatta
Each year more than 35,000 people in the US are diagnosed with multiple myeloma, making it the second most common blood cancer in the country. One in five of those myeloma patients is African American, and the ratio is expected increase to one in four in the next decade.
Not only is multiple myeloma the most common blood cancer in African Americans, but this patient population also face disparities that aggravate their experiences, outcomes, and survival rates with the disease.
Black patients often get diagnosed later with advanced multiple myeloma despite having a younger age of onset, for example, and face double the mortality compared to white patients.
Persistent underrepresentation in clinical trials also means they lack access to novel and experimental treatments that could help them live longer and better. This inadequate representation translates to limited evidence about the studied therapy’s benefits, efficacy, and safety in Black people and other underserved patient populations.
Despite significant progress in multiple myeloma therapies over the years, Black people are less likely to receive mainstay and newer, life-prolonging, and potentially curative treatments, such as chimeric antigen receptor (CAR) T cell therapy.
Chimeric antigen receptor (CAR) T cell therapy: a breakthrough addition to cancer care
CAR T cell therapy is an adoptive cell therapy that involves collecting a patient’s T cells to genetically modify so they can better target and destroy cancer cells. This engineered, living drug is then infused into the patients to help eliminate cancer.
CAR T cell therapy is generally recommended as a last resort for treating blood cancers unresponsive to standard treatments and those that return after treatment. It has been shown to be successful in 80% of recipients, with 58% reaching complete remission. Emerging studies show the potential of this therapy to move up to earlier treatment lines.
CAR T cell therapy, so far, is the only adoptive cell therapy to have received commercialization approval from the FDA and EMA (European Medicines Agency), a testament to its success in treating patients with blood cancers. In addition, more and more evidence suggests that certain CAR T cell products can extend remissions and may even lead to a cure for patients with blood cancers.
Drivers of the unequal distribution of access to CAR T cell therapy
Despite its increased availability and adoption for treating patients with blood cancers, Black people, who are the most affected by multiple myeloma, are the least likely to receive CAR T cell therapy.
Unequal CAR T cell therapy access is driven by multiple barriers, including high cost, transportation difficulties, lower referral rates, geographical limitations, ineligibility due to existing comorbidities, lack of insurance coverage, and lack of caregiver support. For Black people, these obstacles are likely grounded in racial and socioeconomic inequities.
A 2022 study examined racial and socioeconomic disparities in access to CAR T cell therapy for blood cancers, including B cell lymphoma, multiple myeloma, and acute lymphoblastic leukemia, in a real-world setting. Researchers observed that African Americans are less likely to get CAR T cell therapy than other racial and ethnic groups. They are also critically underrepresented in clinical trials; despite accounting for 20% of multiple myeloma cases, only 1% of patients enrolled in clinical trials for multiple myeloma are Black. The study also highlighted that socioeconomic status and insurance coverage contribute to the differences in access to CAR T cell therapy, noting that many of the patients who received CAR T cell therapy lived in high-income neighborhoods and had insurance coverage.
Similarly, a 2022 study examined the enrollment rate of Black patients in clinical trials that led to FDA approval of CAR T cell products for blood cancers. The study found that enrollment of Black patients was exceedingly low; of the 729 participants in clinical trials that resulted in the approval of CAR T cell products, only 2 to 5% were Black patients.
Additionally, the researchers noted out-of-pocket costs and distance to treatment centers as obstacles to receiving CAR T cell products in patients with lower socioeconomic status. They recommended including more medical centers that serve more Black participants in clinical trials to address the uneven distribution of CAR T cell products.
A follow-up study that involved a review of 69 clinical trials was conducted to investigate how location affected the availability of CAR T cell therapy and bispecific antibodies to Black patients. The results showed that of the ten states with the highest percentage of Black residents, three had no clinical trial openings, and three had less than three clinical trial openings for CAR T or bispecific antibody studies. It also found that less than half of Black patients, precisely 35.9%, live in a county with ongoing clinical trials. Hence, the study suggests that geographic limitations widen the gap in access to these therapies for Black patients with multiple myeloma.
Additionally, a 2022 study that looked into demographic differences in recipients of CAR T cell therapy for three diseases commonly treated with it, including non-Hodgkin lymphoma, multiple myeloma, and acute lymphoblastic leukemia, found that people who received CAR T cell therapy in the United States were more likely to be white and live in cities.
Race and ethnicity does not affect CAR-T cell efficacy or neurotoxicity outcomes. Some studies show that Black patients with multiple myeloma may experience even better outcomes than their counterparts when treated equally. Hence, more effort should be directed to enhancing CAR T cell treatment rate in Black patients with multiple myeloma in clinical trials and real-world settings to ensure that this remarkable life-prolonging therapy reaches as many people that may benefit from it.
More reading on cell therapy & healthcare equity:
- How Thermo Fisher Scientific is Expanding Access to Cell and Gene Therapies
- The Importance of Diversity in Clinical Trials: A Q&A with Rose Blackburne, MD, MBA, Vice President and Global Head of Women’s Health/General Medicine at PPD, a part of Thermo Fisher Scientific
- What is CAR-NK Therapy and Is It the Off-the-Shelf Solution the Cancer Research Field Needs?
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