Effect of Race and Ethnicity on Risk of Radiotherapy Toxicity and Implications for Radiogenomics

Ahmed, AbdelKarem Omneya I; Choudhury, Ananya; Burnet, N.G.; Summersgill, H.R.; West, Catharine M L

doi:10.1016/j.clon.2022.03.013

Cited by 13 publications

(4 citation statements)

References 82 publications

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“…Cancer treatment toxicities and adverse effects, including adrenal hormone suppression and radiotherapy, are more pronounced in certain races. Additionally, there are differences in treatment responses across races [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Prostate cancer clinical trials in low- and middle-income countries

Halaseh,

Al-Karadsheh,

Mukherji

et al. 2023

ecancer Journal

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Background Prostate cancer is the second most common form of cancer and a leading cause of cancer-related death in men. In an era of evidence-based medicine, clinical trials play a critical role, and adherence to best practices is crucial in managing complicated and non-communicable diseases, such as prostate cancer. For this reason, extrapolating research conducted in high-income countries (HICs) to low-middle-income countries (LMICs) may lead to incorrect findings or treatment plans for patients in these areas. Unfortunately, clinical trials in LMICs face several challenges in terms of design, funding and recruitment. This study aimed to examine clinical trials on prostate cancer in LMICs, including the scope of these trials, the type of interventions being tested and funding sources. Methods A search of the Cochrane Library Controlled Trials Registry was conducted between January 2010 and June 2021 using keywords including: ‘prostate cancer’, ‘prostate adenocarcinoma’ and ‘prostate tumour’). The trials were classified into either HICs or LMICs based on the World Bank Atlas classification. A descriptive analysis was performed to determine the characteristics of the trials. Results A total of 3,455 clinical trials for prostate cancer have been conducted globally, with 542 (15.68%) conducted LMICs. Most of these trials (89%) were registered in upper-middle-income countries, with none being conducted in low-income countries. The majority of trials were prospective studies (98.1%), with 65.2% being randomised and 57% being phase III. Of the trials, 48.4% aimed to recruit fewer than 500 participants. The main source of funding was pharmaceutical companies in 78.1% of the cases, followed by institutional funds (16.1%) and public funds (5.8%). At the time of the search query, 74.6% of the trials were inactive, with 37% completed, 5% terminated due to insufficient funding and 75% terminated due to medical inefficacy or poor accrual. The majority of trials (88.2%) were interventional, with only 6% focusing on screening and prevention, and 2% designed for palliative care. Conclusion This study sheds light on the challenges faced in conducting clinical trials for prostate cancer in LMICs. The findings underline the need for improved support from international organisations and pharmaceutical companies to bridge the gaps in prostate cancer research and facilitate collaboration between researchers in LMICs and other countries.

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Section: Discussionmentioning

confidence: 99%

Prostate cancer clinical trials in low- and middle-income countries

Halaseh,

Al-Karadsheh,

Mukherji

et al. 2023

ecancer Journal

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“…While language barriers and other socioeconomic factors likely contribute to difference in care between ethnic groups, the effect of race and ethnicity itself has not been examined in most studies assessing radiation therapy toxicity. Toxicity studies often include race in their breakdown of patient characteristics, however, non-Hispanic white breast cancer patients are the most widely studied group (34). Although Hispanics are often grouped into the white category when selecting a race, Hispanics may have different genetic ancestry when compared to non-Hispanic whites and Black patients of African descent.…”

Section: Discussionmentioning

confidence: 99%

Post-Mastectomy Implant Complications in the Hispanic Breast Cancer Patient Population

CONTE,

SHERMOEN,

LUBARSKY

et al. 2023

Anticancer Res

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Background/Aim: The purpose was to analyze the impact of post-mastectomy radiation therapy (PMRT) on implant-based breast reconstruction (IBR) in self-identified Hispanic patients compared to non-Hispanic counterparts. Patients and Methods: We retrospectively reviewed patients who underwent IBR between January 1, 2017 and December 31, 2019 at a single hospital system. Patients were cisgender women, assigned female at birth, 18 years or older, and underwent mastectomy with immediate IBR +/-PMRT. We compared characteristics between Hispanic and non-Hispanic patients, assessing capsular contracture and implant loss rates. Multivariable analysis was performed to identify factors associated with complications. Results: A total of 317 patients underwent mastectomy and reconstruction. Of these patients, 302 underwent a total of 467 mastectomies with IBR, and these 467 procedures were included in the analysis of complications. Complications occurred in 175 breasts (37.5%), regardless of PMRT. Seventy-two of the 302 patients (24%) received PMRT to one breast. The overall rates of capsular contracture, implant loss, and overall complications did not vary significantly between Hispanic and non-Hispanic patients (p=0.866, 0.974, and 0.761, respectively). When comparing only irradiated patients, there was a trend towards increased implant loss and overall complication rates in Hispanic versus non-Hispanic patients (p=0.107 and 0.113, respectively). Following PMRT the rate of any complication was 71% in Hispanic women and 53% in non-Hispanic women. Conclusion: Our study illuminates a trend towards higher complication rates after PMRT in Hispanic versus non-Hispanic patients. Further studies are needed to understand why Hispanic patients may have more side effects from radiation therapy.Breast cancer is the most common type of cancer as well as the leading cause of death in Hispanic women (1, 2). Studies in breast cancer have shown that Hispanic patients are more likely to present with overall later stage at diagnosis (3, 4) when compared to non-Hispanic white patients. Node positive disease increases the likelihood that patients undergoing surgery will be considered for post-mastectomy radiation therapy (PMRT) and be exposed to the potential side effects of radiation therapy. Those belonging to racial or ethnic minority groups are more likely to experience adverse health outcomes, making race and ethnicity important social determinants of health to control for when analyzing complications ( 5). Yet, race and ethnicity as predictive factors of complications have not been included in prior analyses assessing PMRT (5).The primary role of PMRT is to eliminate occult disease, and it has been shown to reduce local recurrence and improve overall survival (OS) in appropriately selected patients (6). Generally, PMRT is reserved for locally advanced disease (T3N1, T4, N2-N3) and is not generally recommended for small, node negative tumors unless there are positive margins or other poor prognostic features. There is still debate regardin...

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“…However, ultra-HF-WBI is not yet clinically practiced in Japan, and its safety in Asian women remains unknown. A potential correlation between ethnicity and radiation therapy toxicities has been suggested, with socioeconomic factors considered potential confounders [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study

Tokuda,

Mitsuyoshi,

Ono

et al. 2024

Breast Cancer

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Background The applicability of ultra-hypofractionated (ultra-HF) whole-breast irradiation (WBI) remains unknown in Japanese women. This study aimed to evaluate the safety and efficacy of this approach among Japanese women and report the results of an interim analysis performed to assess acute adverse events (AEs) and determine whether it was safe to continue this study. Methods We enrolled Japanese women with invasive breast cancer or ductal carcinoma in situ who had undergone breast-conserving surgery, were aged ≥ 40 years, had pathological stages of Tis–T3 N0–N1, and had negative surgical margins. Ultra-HF-WBI was delivered at 26 Gy in five fractions over one week. When the number of enrolled patients reached 28, patient registration was paused for three months. The endpoint of the interim analysis was the proportion of acute AEs of grade ≥ 2 (Common Terminology Criteria for Adverse Events v5.0) within three months. Results Of the 28 patients enrolled from seven institutes, 26 received ultra-HF-WBI, and 2 were excluded due to postoperative infections. No AEs of grade ≥ 3 occurred. One patient (4%) experienced grade 2 radiation dermatitis, and 18 (69%) had grade 1 radiation dermatitis. The other acute grade 1 AEs experienced were skin hyperpigmentation (n = 10, 38%); breast pain (n = 4, 15%); superficial soft tissue fibrosis (n = 3, 12%); and fatigue (n = 1, 4%). No other acute AEs of grade ≥ 2 were detected. Conclusions Acute AEs following ultra-HF-WBI were within acceptable limits among Japanese women, indicating that the continuation of the study was appropriate.

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Effect of Race and Ethnicity on Risk of Radiotherapy Toxicity and Implications for Radiogenomics

Cited by 13 publications

References 82 publications

Prostate cancer clinical trials in low- and middle-income countries

Prostate cancer clinical trials in low- and middle-income countries

Post-Mastectomy Implant Complications in the Hispanic Breast Cancer Patient Population

Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study

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