Black mirror.

Top Line: In contrast to commonly held assumptions, many differences in prostate cancer outcomes actually favor black men.
The Study: In this meta-analysis, survival outcomes were compared between black and white men with metastatic, castration resistant prostate cancer (mCRPC) receiving docetaxel in ten phase 3 trials. Among the nearly 9K enrolled, a measly 6% were black. That is in comparison to the 12% of the US population who is black and who, by the way, have a higher incidence of prostate cancer. Interestingly, trials done by the National Clinical Trials Network (NCTN) were more representative with 12% of enrollees being black versus 4% in industry-sponsored trials. Overall, median survival was 21 months across race. However, a pooled multivariable analysis revealed significantly lower risk of death for black men. And this was despite black men having significantly higher testosterone (20 vs 18 ng/mL) and PSA levels (127 vs 85 ng/mL). Importantly, the hazard ratio seen here (0.8) is very similar to that seen in a recent meta-analysis of RTOG radiation trials. What is all this data suggesting? We need to look closer at race so we can look beyond race in prostate cancer. By delving deeper into molecular phenotypes enriched among black men, we may be able to better predict therapeutic response for prostate cancer among patients of any race.
Bottom Line: Black men with mCRPC treated with docetaxel in clinical trials appear to have a lower risk of death than their white counterparts. | Halabi, J Clin Oncol 2018


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