BCRF Project Aims to Resolve Disparities in Breast Cancer Clinical Trials

BCRF investigator Nikhil Wagle discusses the importance of minority population participation in clinical trials.

Invited guest blog

Breast cancer mortality rates are higher for African-American women than Caucasian women. However, the influence of tumor biology on this racial disparity is unclear. The genomics of tumors from African American patients with breast cancer remains understudied, with only a small fraction of The Cancer Genome Atlas (TCGA) being comprised of African American patients.

BCRF researcher Dr. Nikhil Wagle is seeking to solve this problem. In his BCRF-supported project, he is characterizing tumors of African American patients with metastatic breast cancer in order to better understand the biological reasons for these disparities. Patients will be selected for study through The Metastatic Breast Cancer Project, a nationwide initiative that seeks to empower patients to accelerate research by sharing their samples and clinical information.

On Martin Luther King Jr. Day, Dr. Wagle discusses the importance of clinical trials in advancing breast cancer research, why minority population participation is key and updates from the Metastatic Breast Cancer Project.

Why are clinical trials important for breast cancer patients? 

Thanks to breast cancer research, which has led to groundbreaking new treatments and treatment strategies, the mortality rate from breast cancer has decreased nearly 40 percent over the past two decades.  However, despite these advances, more than 40,000 people in the U.S. die from breast cancer each year, accounting for 14 percent of cancer deaths among women.  More research is clearly – and urgently –  needed. 

One of the main reasons for the improvement in breast cancer survival has been the study of novel agents and therapeutic strategies through clinical trials. The goal of clinical trials is to identify better treatments and other approaches that will improve the lives and outcomes of patients with breast cancer. They are the only way to determine if a promising new treatment is better than the current standard of care. 

Common patient concerns about clinical trial participation

For some patients, clinical trials are a cause for concern. Below are common misgivings I try to dispel: 

Clinical trials are a “last resort” after all other options have been exhausted.  In some cases, yes, but there are clinical trials to benefit patients in variety scenarios, such as early stage breast cancer, newly diagnosed metastatic breast cancer and breast cancer that has become resistant to other therapies. 

I might be in a placebo group that doesn’t get the new drug or therapy. Clinical trials don’t always involve getting randomly assigned to a treatment, and in most clinical trials in breast cancer no one receives a placebo. 

I don’t want to be a “guinea pig.” Patients enrolled in clinical trials get the best care possible. Clinical trials can always be considered when making a treatment decision.

Minority participation in clinical trials is important, particularly for black women

Black women are 40 percent more likely to die from breast cancer–and this disparity has been increasing as treatments for breast cancers have improved. Black women are also more likely than white women to get breast cancer before age 40, and they also have the highest rates of triple negative breast cancer (TNBC), an aggressive subtype for which we have more limited therapeutic options. 

These statistics speak to the urgency in understanding these differences to improve outcomes for black women with breast cancer. One solution is to make clinical trials more inclusive, more diverse, and more representative of all people who get breast cancer.  This means that researchers need to think carefully about eligibility criteria, recruitment strategies and patient access to trials.  There is a long history of medical mistrust in the African American community because of years of abuse endured by black patients. The research community must focus on listening to and learning from minority populations in order to understand how we can work together to overcome these challenges. 

Studying tumor biology to reduce breast cancer disparities

My laboratory at Dana-Farber Cancer Institute and the Broad Institute focuses on understanding the biology of metastatic breast cancer, to develop new ways to overcome or prevent drug resistance in patients with advanced breast cancer and identify characteristics of tumors that might improve clinical decision-making for patients.

One of our goals is to better understand racial disparities in breast cancer and help improve outcomes for African American women with breast cancer. While there has been a lot of progress in understanding the biology of breast cancer, we still know very little about the influence of tumor biology on these racial disparities in breast cancer, mainly because the genomic and molecular underpinnings of tumors from black patients with breast cancer remain understudied.

The MBC Project: Engaging African American breast cancer patients 

Two years ago, we launched the Metastatic Breast Cancer Project, a patient-driven research study that directly engages patients with metastatic breast cancer via social media and advocacy groups – and empowers them to accelerate research by sharing their samples and clinical information. In the two years since the project was launched, more than 4,200 patients from over 1,000 institutions in all 50 states and several additional countries have enrolled in the study.  

An important piece of MBC project that is generously supported by BCRF, is the detailed study of tumor samples and saliva samples from African American patients with metastatic breast cancer.  We have worked closely with African American patients and advocates to better understand the disparities that exist in this population and our goal is to work with many underrepresented communities in order to address the disparities in research participation.

We are grateful for the support from BCRF to study racial disparities in breast cancer outcomes and working together, we look forward to making progress in improving the lives of breast cancer patients.

Learn more about the MBC project in African American women and how you can get involved in this short video.

Dr. Nikhil Wagle is an Assistant Professor of Medicine at Harvard Medical School, a medical oncologist at Dana-Farber Cancer Institute, and an associate member of the Broad Institute of MIT and Harvard. He is the Deputy Director of the Center for Cancer Precision Medicine at Dana-Farber Cancer.