Health Disparity in African Americans: A Meta-Analysis of Six Phase III Trials in Metastatic Castration-Resistant Prostate Cancer Men Treated with Docetaxel
Abstract
Objectives and Rationale: The mortality and incidence rates of prostate cancer (PC) are higher among African-American (AA) men than white men. Moreover, AA men have twice as high the PC incidence and mortality compared to white men with similar socioeconomic background. Recently, five therapeutic options that prolong life have been developed and approved by the Food and Drug Administration for men with metastatic castration resistant prostate cancer (mCRPC). Despite, and in fact because of this, risk and identifying patients who may benefit from different treatments remains a critically important task. Docetaxel plus prednisone is considered as the only chemotherapy standard of care for men with mCRPC who have never received prior chemotherapy. But due to the limited number of AA enrolled in these trials, the efficacy of docetaxel in AA men is largely unknown. This may present a significant treatment barrier for physicians and AA men with CRPC. Thus, there is a great need to accurately assess the risk of disease progression and overall survival in AA men with mCRPC treated with a docetaxel-based regimen. Management of prostate cancer in senior adults represents an important challenge as the median age at diagnosis is 68. The prognostic importance of race and host factors (such as, age genetic markers, comorbidity status, body mass index) in men with CRPC has not been investigated. We will evaluate the host and tumor factors in AA and white men to understand the complex relationship among them and their impact on clinical outcomes. Patient Population: We will be studying a group of men with advanced CRPC who were treated with docetaxel. Men who participated in the trials had advanced stage of PC that had progressed after hormonal treatment. In addition, they were generally healthy, did not receive any prior chemotherapy, had performance status of 0-2 and adequate liver, kidney, and bone marrow functions. Clinical Applications: If these results are validated, then host prognostic factors such as race, genetic markers, and comorbidity status can be used prospectively in randomized trials to ensure that the treatment groups being evaluated are comparable. Furthermore, they can assist in identifying subgroups of men with CRPC with particularly good or poor prognoses for whom therapy can be subsequently tailored. These factors can be incorporated into management of patients. Contributions: Determining whether there are racial differences in host, tumor factors, and genetic markers is critical not only for the physician but to the men with mCRPC and their families. We expect to identify specific genetic markers and host factors that are unique to AA men with advanced disease, thus providing insights into the race-specific genetic landscape. These findings will inform strategies incorporating genetic markers for the medical management of AA men with mCRPC, such as optimal treatment, alternative treatment, monitoring, and surveillance, which will ultimately reduce prostate cancer-specific morbidity and mortality in AA men.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1510467
Entities
People
- Susan Halabi
Organizations
- Duke University
- United States Army