Health Disparities and the Global Landscape of Lymphoma Care Today

The American Society of Clinical Oncology (ASCO) Annual Meeting brings together more than 30,000 oncology professionals each year to encourage discourse on leading research, state-of-the-art treatments, and ongoing controversies in the field. At this year’s Annual Meeting in Chicago, our own Dr. Adrienne Phillips was selected to present a review of the current health disparities in lymphoma care.

Adrienne Phillips

According to the National Institute on Minority Health and Health Disparities, health disparities are defined as “differences in incidence, prevalence, morbidity, mortality and burden of diseases and other adverse health conditions that exist among specific population groups.”

Dr. Phillips explained that health disparities may be due to a variety of factors, including race, gender, biology, and social and environmental differences such as socioeconomic status, health literacy, trust in the healthcare system, proximity to a healthcare facility, and access to and type of health insurance. For example, being uninsured or receiving government-assisted insurance increases patients’ risk of death by 1.5 times. Even patients’ place of residence may play a role, with treatment in rural, community-based settings being associated with inferior overall survival (OS) rates compared to treatment in urban, academic-based settings.

What Dr. Phillips and other physicians find most disconcerting about disparity in lymphoma care is that the disease is often amenable to effective therapy, but a significant segment of the population does not, or cannot, access appropriate care. For example, survival rates for some lymphomas skew lower for black people than for white people. Dr. Phillips conjectured that while African Americans tend to have poorer outcomes, the disparity is likely due to issues related to healthcare access and socioeconomic status.

According to an analysis of 701 people with diffuse large B-cell lymphoma (DLBCL) treated at two southern referral centers with a large black patient population (University of Alabama at Birmingham and Emory University in Atlanta), race did not influence outcomes. Black and white patients who received standard DLBCL chemotherapy drug combination rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP) achieved similar OS rates (5y OS, 79% vs 70%).

Biological factors may also play a role in health disparities, and scientists are constantly working to better understand molecular factors in tumor development regardless of patient ethnicity.

In general, lymphoma is less common among African Americans and Asian Americans, but specific subtypes – like T-cell lymphoma in African Americans and natural killer T-cell (NKT) lymphoma in Asian Americans – are more common in these populations. Thus, Dr. Phillips highlighted a need for ethnic and racial diversity in clinical trial recruitment and in future studies of socioeconomic status and disease biology in order to better understand and improve outcomes for all patients.

Immunotherapy More Effective in Treating Aggressive Lymphoma than Chemotherapy

Dr. Adrienne Phillips
Dr. Adrienne Phillips

According to findings from a recent clinical trial, people with relapsed or refractory adult T-cell leukemia-lymphoma (ATLL) may have a promising new treatment option. This new option is mogamulizumab, an immunotherapy that augments the immune system in its fight against this aggressive form of lymphoma. The lead author of the study is Dr. Adrienne Phillips, an assistant professor of medicine and a member of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine and an oncologist with the Bone Marrow and Stem Cell Transplant Program at NewYork-Presbyterian/Weill Cornell Medical Center.

The findings of a small clinical trial demonstrate that the antibody drug mogamulizumab, known as moga, induces tumor responses in nearly 28 percent of patients with a fast-growing and difficult to treat blood cancer called relapsed or refractory adult T-cell leukemia-lymphoma (ATLL). These response rates appeared better than the standard chemotherapy comparison results in this study. The investigators say moga may represent a breakthrough in treating ATLL, for which there are currently no drugs approved in the United States to specifically treat the disease. Mogalizumab binds to CCR4 proteins on tumor cells, allowing the immune system to better target them.

“In order to treat an aggressive cancer such as ATLL, you have to think outside the box,” said Dr. Adrienne Phillips…”By working with international collaborators to conduct the largest randomized trial ever in relapsed or refractory forms of this devastating cancer, we have been able to demonstrate the benefits of an innovative, immune based treatment approach and have taken a large step forward in efforts to make this treatment option available for ATLL patients here.”

Dr. Phillip’s findings were presented during the annual meeting of the American Society for Clinical Oncology (ASCO) on June 5th in Chicago. You can read more about her finding’s here.