O'Neal Comprehensive Cancer Center Magazine Spring 2020 | Seite 28

A BOLD MOVE
By Matt Windsor
Academic conferences tend to be serious affairs.
Practitioners, especially those in combat with
a foe as wily as cancer, do not get too excited
because they have seen enough promising ideas
falter. But there was something different about this
presentation and this trial, thought Luciano Costa, M.D.,
Ph.D., a scientist at the O’Neal Comprehensive Cancer
Center at UAB and associate professor in the Division of
Hematology & Oncology.
Costa and his wife, Ana Xavier, M.D., Ph.D., a pediatric
hematologist and oncologist, always attend the annual
meetings of the American Society of Hematology, but they
have different clinical and research interests and attend
their own sessions. Still, last December in San Diego,
California, “I told my wife, ‘Come to my presentation
today; I’m presenting my dream trial,’” Costa said.
He only had the usual 10 minutes to share the preliminary
results of his innovative multiple myeloma trial, MASTER,
which is taking an unusually aggressive approach to wipe
out a blood cancer currently considered incurable. For
some patients, at least, this could mean freedom from a
lifetime of continuing therapy.
The results were unprecedented – “the highest and
deepest level of response ever reported on a myeloma
trial,” Costa said. That earned him a warm round of
applause from the clinician-scientists present.
It was his last slide, though, that made the presentation
unforgettable. Costa noted that 21 percent of the
participants were African American.
An oncologist from Indiana, himself African American,
pointed to that statistic. “He asked for another round of
applause, which is very unusual,” Costa said. “I choked
up. It was very touching, and whatever else I do, it will be
a highlight of my career.”
A fraction of a fraction
Clinical trials are closely associated with cancer,
but Costa says the reality is that “only a very small
proportion of cancer patients participate in clinical trials
in the United States.”
According to Costa, fewer than 5 percent of cancer
patients participate in clinical trials, even though studies
show that patients who take part in clinical trials have
better outcomes than those who do not.
The reasons for low clinical trial participation are
complex and include the ways that a health care
system is structured, as well as physician attitudes and
preconceived notions about clinical trials on the side of
patients, Costa says.
The problem is worse for underrepresented minority
populations. A 2019 study published in the American
Society of Clinical Oncology Educational Book
examined several clinical trials of highly promising
immunotherapy treatments in a number of different
cancer types and found that African American patients
accounted for fewer than 4 percent of those who
participated.
“UAB has the longest-established [National Cancer
Institute-designated] comprehensive cancer center
in the Deep South,” Costa said. “We have a unique
opportunity and a unique charge to promote and
advance clinical trial participation among minorities.”
This is especially true for cancers such as multiple
myeloma, the second most common type of blood
cancer in the U.S.
Multiple myeloma affects more than 25,000 people each
year, and African American men are diagnosed at three
times the rate of other populations.
Costa says that the 21-percent figure cited in his
presentation at the American Society of Hematology
conference in December 2019 represented the total
number of African Americans enrolled at all MASTER
study locations.
The MASTER trial opened enrollment in 2018 at
six universities: UAB, Vanderbilt University, Duke
University, the Medical College of Wisconsin, the
University of Wisconsin and Oregon Health and
Science University.
Luciano Costa, M.D., Ph.D.
“At UAB, our number was closer to 40 percent,” Costa
said. “It’s a great case study. If you have a coordinated
effort and motivated investigators, you can do great
things.”
26 O’NEAL COMPREHENSIVE CANCER CENTER AT UAB