News
UK launches project to improve diversity in breast cancer trials
Data from across the UK show women from an ethnic minority background are poorly underrepresented in clinical trials
The UK’s NHS Race and Health Observatory has announced a new pilot project to increase the number of black, Asian and ethnic minority patients taking part in breast cancer clinical trials.
Launched in partnership with Macmillan Cancer Support and supported by pharmaceutical giant Roche, the campaign aims to improve health equity in breast cancer clinical trial representation by raising awareness, improving communications and providing longer-term support to patients.
The project is hoped to design new ways for people with breast cancer to access clinical trials and better information processes.
It will involve recruitment of two specialist nurses – one at The Christie and one at Bart’s Health – employed to give patients one-on-one support throughout the process.
As part of the collaboration, the Caribbean African Health Network will lead on engaging breast cancer service users in the wider community, beyond clinical settings.
There are multiple barriers around recruitment, communication and retention of black, Asian and ethnic minority patients in clinical trials.
The NHS Race and Health Observatory said historically, data from across the UK show people from an ethnic minority background are poorly underrepresented in many clinical trials.
Current research from the UK Health Security Agency and Breast Cancer.Org show that when it comes to breast cancer, young black women in particular have more aggressive tumour profiles, present with later stages of disease, have higher mortality rates, and experience poorer cancer care, further strengthening the rationale to increase participation from these groups in clinical trials.
“Across the Black community there is an undoubted legacy of disengagement in research and most certainly clinical trials that stems back decades as a result of mistrust,” said Charles Kwaku-Odoi, chief executive of the Caribbean African Health Network.
This has not served us well because it leads to a lack of appropriate interventions that perpetuate the grave health inequalities in breast cancer care.
“This partnership approach to build solutions to improve engagement in clinical trials in breast cancer treatment and care is very much welcomed.
“We are looking forward to working in a collaborative way to build trust, improve awareness and ensure that barriers surrounding access to clinical trials are addressed.”
‘White person’s disease’
Dr Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: “There is a broad misperception that black women don’t suffer as much from breast cancer or it does not run in their family history.
“This can result in the perception that cancer is a white person’s disease. We want this pilot to encourage women at risk, those already diagnosed and individuals undergoing post treatment to come forward and share their experiences and get the information needed.”
He added: “We believe that when targeted, culturally sensitive interventions and communications are put in place, underrepresented groups can be successfully recruited into clinical trials.
“There is no ‘hard to reach’ community when it comes to addressing potentially fatal health conditions.”
Professor Richard Simcock, chief medical officer at Macmillan Cancer Support, said: “As a breast cancer oncologist, I want to know that research is relevant to the people we see in clinic. Historically that has not been the case.
“I’m delighted that Macmillan can support this project to ensure that future evidence from clinical trials is representative and inclusive.”
Richard Erwin, general manager at Roche Products, added: “The recruitment of people from minority ethnic groups is a pressing concern for researchers and the research community.
“Roche is committed to overcoming these disparities and addressing barriers to clinical trial participation across all patients and groups.
“Programmes such as this one are vital in helping us enhance the future designs of our clinical trials and ensure greater inclusion and better patient access to all of our clinical trials.”
Diagnosis
Lung cancer drug shows breast cancer potential
Ovarian cancer cells quickly activate survival responses after PARP inhibitor treatment, and a lung cancer drug could help block this, research suggests.
PARP inhibitors are a common treatment for ovarian cancer, particularly in tumours with faulty DNA repair. They stop cancer cells fixing DNA damage, which leads to cell death, but many tumours later stop responding.
Researchers identified a way cancer cells may survive PARP inhibitor treatment from the outset, pointing to a potential way to block that response. A Mayo Clinic team found ovarian cancer cells rapidly switch on a pro-survival programme after exposure to PARP inhibitors. A key driver is FRA1, a transcription factor (a protein that turns genes on and off) that helps cancer cells adapt and avoid death.
The team then tested whether brigatinib, a drug approved for certain lung cancers, could block this response and boost the effect of PARP inhibitors. Brigatinib was chosen because it inhibits multiple signalling pathways involved in cancer cell survival.
In laboratory studies, combining brigatinib with a PARP inhibitor was more effective than either treatment alone. Notably, the effect was seen in cancer cells but not normal cells, suggesting a more targeted approach.
Brigatinib also appeared to act in an unexpected way. Rather than working through the usual DNA repair routes, it shut down two signalling molecules, FAK and EPHA2, that aggressive ovarian cancer cells rely on. FAK and EPHA2 are proteins that relay survival signals inside cells. Blocking both at once weakened the cells’ ability to adapt and resist treatment, making them more vulnerable to PARP inhibitors.
Tumours with higher levels of FAK and EPHA2 responded better to the drug combination. Other data link high levels of these molecules to more aggressive disease, pointing to potential benefit in harder-to-treat cases.
Arun Kanakkanthara, an oncology investigator at Mayo Clinic and a senior author of the study, said: “This work shows that drug resistance does not always emerge slowly over time; cancer cells can activate survival programmes very early after treatment begins.”
John Weroha, a medical oncologist at Mayo Clinic and a senior author of the study, said: “From a clinical perspective, resistance remains one of the biggest challenges in treating ovarian cancer. By combining mechanistic insights from Dr Kanakkanthara’s laboratory with my clinical experience, this preclinical work supports the strategy of targeting resistance early, before it has a chance to take hold. This strategy could improve patient outcomes.”
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