Racial Disparities Persist in Triple-Negative Breast Cancer Trials Despite Treatment Advances

Key Insights

• Black women face disproportionate burden of triple-negative breast cancer with higher incidence and mortality rates, yet comprise only 6.5% of clinical trial participants versus 14.4% US population representation.
• Recent advances in small cell lung cancer treatment include promising DLL3-targeting therapy tarlatamab-dlle, offering new hope for patients with disease progression after platinum-based chemotherapy.
• FDA's approval of fam-trastuzumab deruxtecan-nxki marks significant progress in site-agnostic cancer therapy, demonstrating efficacy across multiple HER2-positive solid tumors.

The oncology landscape continues to grapple with significant racial disparities in clinical trials, particularly affecting Black women with triple-negative breast cancer (TNBC), even as revolutionary treatments emerge across multiple cancer types.

Persistent Disparities in TNBC Clinical Trials

Recent analysis of FDA-approved TNBC therapies from 2019 to 2023 reveals a stark underrepresentation of Black women in clinical trials. Despite Black women facing higher incidence rates and poorer prognosis in TNBC, their trial participation remains at a mere 6.5% - less than half of their 14.4% representation in the US population. This disparity highlights the urgent need for systemic changes in clinical trial recruitment and accessibility.

Breakthrough in Small Cell Lung Cancer Treatment

In the challenging landscape of small cell lung cancer (SCLC), where five-year survival rates remain below 10%, new targeted therapies are offering fresh hope. The emergence of DLL3 as a therapeutic target, expressed in 80% of SCLC cells, has led to significant developments. Notably, tarlatamab-dlle (Imdelltra) has demonstrated promising durability in responses for patients who progressed after platinum-based chemotherapy, though requiring vigilant monitoring for cytokine release syndrome and neurological side effects.

Expanding Horizons with Site-Agnostic Cancer Therapy

A major breakthrough came with the FDA's April 2024 approval of fam-trastuzumab deruxtecan-nxki (Enhertu) for HER2-positive solid tumors. This approval represents a paradigm shift in cancer treatment, moving beyond traditional site-specific approaches. The DESTINY-PanTumor02 trial demonstrated particularly strong responses in gynecologic malignancies, suggesting broader applications for targeted therapies.

Path Forward in Oncology

The field of oncology stands at a crucial intersection where technological advances must be balanced with equitable access. Addressing the underrepresentation of minority populations in clinical trials remains paramount, while emerging targeted therapies and site-agnostic approaches offer new possibilities for treatment. Success in both areas will be critical for advancing cancer care that serves all patient populations effectively.