NRG Oncology

Head and neck cancer trials showed worsening racial and ethnic diversity despite efforts, suggesting new strategies are needed to address inequities in cancer clinical trials.

Researchers from Boston University and Boston Medical Center found that head and neck cancer clinical trials are becoming less racially and ethnically diverse over time, despite efforts by organizations like the FDA and NCI. The inequitable representation in cancer research has worsened in the last decade. BMC's initiatives have improved diversity in their trials, with 58% of participants from underrepresented groups, compared to the national average of 7-12%.

Despite national efforts, head and neck cancer clinical trials are becoming less racially and ethnically diverse, highlighting the need for more inclusive approaches to improve treatment outcomes for all patients.

A phase 3 trial found no OS improvement with atezolizumab in LS-SCLC, but 45 Gy twice daily radiation showed better OS than 66 Gy once daily. Median OS was 39 months in the control arm and 33 months in the atezolizumab arm. Adverse events were similar in both arms, with more fatal AEs in the atezolizumab arm.

Elevated circulating tumor cell (CTC) count at baseline in metastatic hormone-sensitive prostate cancer (mHSPC) is associated with worse overall survival, progression-free survival, and treatment response, validating CTC count as a prognostic biomarker that improves existing prognostic factors and estimates divergent survival outcomes regardless of subsequent therapies.

De-escalation strategies for HPV-positive oropharyngeal cancer failed to show noninferiority compared to standard care, resetting the bar for future trials. Standard treatment with 70 Gy RT plus cisplatin achieved 98.1% 2-year PFS, while de-escalated strategies with 60 Gy RT plus cisplatin or nivolumab yielded 88.6% and 90.3% PFS, respectively. Future de-intensification studies must be more selective and effective.

Immunotherapy added to chemoradiotherapy for limited-stage small cell lung cancer does not improve survival when given concurrently, but twice-daily radiation does. Timing of immunotherapy is crucial; it is more effective when added after standard treatment.

40% of brain cancer patients who experienced cognitive issues after radiation regained full function within six months, with better recovery from targeted vs. whole-brain radiation. A separate study at ASTRO highlighted Black patients' views on clinical trials, revealing higher mistrust and spiritual beliefs affecting participation.

The NRG-HN005 phase II/III trial failed to meet non-inferiority criteria for p16+ oropharyngeal cancer patients, affirming traditional chemoradiation's effectiveness. The study compared standard IMRT and cisplatin to lower dose IMRT with cisplatin or nivolumab, but interim futility analysis showed the control arm's 2-year PFS rate of 98.1% was too high for experimental arms to be deemed non-inferior.