Dr. Namrata S. Chandhok from Sylvester Comprehensive Cancer Center is doing important research into improving drug efficacy for underserved populations. She specifically references acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) during this conversation. Dr. Chandhok highlights the need we have in the research field for both more inclusive clinical trials and greater diversity in genome-wide sequencing databases. A more inclusive database would help ensure that drugs are designed for all populations, not just majority populations.

As Dr. Chandhok states during our conversation, the largest growing population in the United States is individuals of Hispanic origin. We know that people of different racial/ethnic backgrounds react and respond to medications in different ways. With this knowledge, we can see that there is an important need to have clinical trials in the U.S. accurately represent the population of U.S. citizens, so that the drugs we are approving and giving patients are safe and tested for their specific background. 

There has been a push recently to increase participation in clinical trials from minority populations, but we're still struggling to get the diversity that would more adequately represent our overall U.S. population. Dr. Chandhok talks about why this might be including past mistreatment and experimentation on minority groups. This historical precedent makes being willing to trust and participate a difficult decision for some individuals in minority populations. 

Doctors like Dr. Chandhok who see this as a problem and are dedicated to righting historical wrongs, are doing critically important work to build trust and improve treatment in populations that have been previously underserved.

Watch the video below to hear Dr. Chandhok talk more in depth about her important research.

“Things that in my research I'm pursuing, obviously, I do a lot of my trials are more focused on MDS and since those are in progress it's not probably worth talking about quite right now, but beyond that, there are two subpopulations that we look at a little bit more extensively here which is treatment related myeloid disease or, you know, diseases like MDS and AML, and how do we improve outcomes of that? 

So that is a very particular initiative here in addition to looking at patients specifically of Hispanic origin and seeing how their disease is different. We do know they get diagnosed at an earlier age at this point based on the available information. What's less clear, is if their outcomes are different from, you know, your Caucasian patients overall, and also improving clinical trial enrollment for minority populations. So, whatever might be relevant we can talk about that but  that's you know some of the more Sylvester specific things or my research specific things.

So one of the big initiatives at Sylvester that I work on is, how do we include minority populations in clinical trials more effectively both for acute myeloid leukemia and MDS. We know that there are some differences in the characteristics of MDS in patients of Hispanic origin, we don't necessarily know the full depth of what we can know in the future just because it was not well indexed on prior clinical trials and it's a work in progress at this time. 

One of the important initiatives given that, you know, the largest growing population in the US is of Hispanic origin, is to better understand both the needs of these patients as well as drug effects on these patients because drugs don't work the same on every subset of patient meaning your racial background, your ethnic background, all can have effects on how you metabolize a drug, how the drug treats you as a patient, and for us to know which drugs will work more effectively in particular subsets are important so we're working on one improving awareness, improving you know materials and accessibility to trials. 

Beyond that, understanding kinetics off of drugs more specifically in Hispanic patients so much of our our testing for patients you know information where new drugs come from is from
genome-word sequencing proteomics, you know, these large databases basically which have information. Quite sadly, the vast majority of these patients are of European origin, so when we are first designing drugs, they are all focused on patients coming from a very particular subset, a very specific geographic distribution. 

This kind of points us towards the fact that we may be designing drugs not for everyone. Because of this, the platform that does all of these analysis has encouraged other minority populations to be more involved, but even now it's less than five percent of that larger database, particularly in historically underserved populations, so improving that initial source data is really important to make good advancements in drugs. Beyond that, making sure that every drug is studied in a diverse population also becomes important, because what might benefit one population may not benefit to the same extent another.

There are historical reasons that, you know, underserved populations may not want to participate in clinical trials primarily because they were feeling like guinea pigs because of drug development during the Holocaust or, you know, on black patients in the US in particular or really anywhere. This has become something that is of concern to many minority patients and I think what we need now to remedy, is to make sure that they are getting the best treatment as  their white counterparts and help try and remedy this discrepancy that has been created by historical wrongdoings.”