Dr Joseph Mikhael on Strategies to Increase Diversity in Multiple Myeloma Trials

Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, highlights several potential strategies to address the historic lack of diversity in multiple myeloma (MM) clinical trial populations.

Transcript

What efforts are being made to ensure diversity and representation of underrepresented groups in clinical trials for MM studies?

This is a great disparity in multiple myeloma where now, in the United States, we estimate that approximately 20% of all patients with myeloma are of African American descent, like myself. And yet, representation in clinical trials has historically been somewhere between 5% to 8%, and arguably even less in pivotal trials that have led to drug approval.

This is a grave problem, because it's not only a lack of representation in those trials, it's a lack of understanding of the efficacy and toxicity of these agents in all different patients. We're already starting to see in immunotherapies, there can be differences in the rates of cytokine release syndrome and neurological toxicities in patients of African descent and in Hispanic American patients, for example.

So this is a huge problem, and I think there isn't going to be a simple and rapid solution, but many solutions are being proposed that include addressing the hierarchical system of systemic racism, of access to health care, of trust within the system—but also very pragmatic answers of ensuring that clinical trials have a diversity officer, that the materials are designed to be able to be read by and supported by a diverse population that we, as health care providers, are trained in understanding culturally sensitive care, so that we can not be a barrier but be a facilitator of the best care of our patients, which very often includes clinical trials.

These are just some of the highlighted issues that I think will help solve the problem as we tried to develop a system that has much greater community engagement. I think that has been a missing piece in our health care systems: that we've been so focused on explicit health care that we haven't looked at the greater interest of engaging our communities at large, which will build that trust [and] which will build that confidence to be able to work together more.