Adequate Underrepresented Minority Representation in Cancer Trials: Evidence from an NCI-Designated Center in a Minority County

Adequate Underrepresented Minority Representation in Cancer Trials: Evidence from an NCI-Designated Center in a Minority County | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 21 April 2025 V1 Latest version Share on Adequate Underrepresented Minority Representation in Cancer Trials: Evidence from an NCI-Designated Center in a Minority County Authors : Frank Lee 0000-0002-7217-1779 , Aditya Mahadevan 0000-0002-2834-5487 , Armon Azizi , Jennifer Valerin , Nataliya Mar , Deepa Jeyakumar , and Farshid Dayyani [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174524077.78834283/v1 193 views 119 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Significant racial and ethnic disparities continue to persist in clinical trial enrollment. This limits the generalizability of clinical trial data and consequently the application of novel therapeutics for diverse populations. We hypothesized that enrollment of underrepresented minorities (URM) is feasible, with improved access to clinical care and a tailored clinical trial portfolio addressing the unmet needs in URM. Methods: A retrospective cohort study was conducted at the University of California Irvine Chao Comprehensive Cancer Center (CFCCC), an NCI-Designated cancer center located in Orange County (OC), CA (a minority-majority county). Clinical trial enrollment data from 2015-2023 through the CFCCC clinical research database was included. Collected data on patient demographics, tumor types, and trial enrollment was compared to data provided by the NIH SEER reports in both OC and United States. Results: Between 2015-2023, 2317 subjects were enrolled. Demographics were as follows: White, Asian, Black, American Indian/Alaska Native, mixed/unknown race (66.4%/20.1%/2.4%/0.7%/0.7%/ 9.3%). Non-Hispanic vs Hispanic ethnicity (77.8%/20.5%). Female vs Male sex (47.6%/52.3%). Age 70 years (73.3%/26.7%). Low Income/Health Professional Shortage Areas (HPSA) vs non-Low Income/HPSA (44.8%/55.1%). Study Phase: Phase I/II (35.6%), Phase II (25.4%), Phase II/III (2.8%), Phase III (26.6%), and Phase IV (0.3%). Study sponsor: Industry (61.1%), Institutional (23.6%), National (14.8%), and Externally Peer Reviewed (0.3%). Most notably, the Asian enrollment (20.1%) and Hispanic enrollment (20.5%) exceeded demographic representation of Asians (17%, RR 1.18) and Hispanics (19%, RR 1.07) at CFCCC. Asians enrolled at significantly higher rates for lung and liver cancer, Hispanics for breast cancer, and Blacks for prostate cancer. Conclusions: Our results demonstrate that URM clinical trial enrollment, particularly among Asian and Hispanic populations, is feasible at an NCI-designated cancer center. Further research is necessary to investigate factors that influence clinical trial participation in the pursuit of equitable cancer care. Adequate Underrepresented Minority Representation in Cancer Trials: Evidence from an NCI-Designated Center in a Minority County *Frank Lee, BS 1 , *Aditya Mahadevan, MD 2 , Armon Azizi, MD 3 , Jennifer Valerin, MD, PhD 4 , Nataliya Mar, MD 4 , Deepa Jeyakumar, MD 4 , Farshid Dayyani, MD, PhD 4 1 University of California, Irvine School of Medicine, Irvine CA; 2 Department of Medicine, University of California San Francisco, San Francisco CA; 3 Department of Medicine, University of California San Diego, San Diego CA; 4 Department of Medicine, Division of Hematology-Oncology, and Chao Family Comprehensive Cancer Center, UC Irvine Health, Orange, CA, USA.) *These authors contributed equally Abstract Background: Significant racial and ethnic disparities continue to persist in clinical trial enrollment. This limits the generalizability of clinical trial data and consequently the application of novel therapeutics for diverse populations. We hypothesized that enrollment of underrepresented minorities (URM) is feasible, with improved access to clinical care and a tailored clinical trial portfolio addressing the unmet needs in URM. Methods: A retrospective cohort study was conducted at the University of California Irvine Chao Comprehensive Cancer Center (CFCCC), an NCI-Designated cancer center located in Orange County (OC), CA (a minority-majority county). Clinical trial enrollment data from 2015-2023 through the CFCCC clinical research database was included. Collected data on patient demographics, tumor types, and trial enrollment was compared to data provided by the NIH SEER reports in both OC and United States. Results: Between 2015-2023, 2317 subjects were enrolled. Demographics were as follows: White, Asian, Black, American Indian/Alaska Native, mixed/unknown race (66.4%/20.1%/2.4%/0.7%/0.7%/ 9.3%). Non-Hispanic vs Hispanic ethnicity (77.8%/20.5%). Female vs Male sex (47.6%/52.3%). Age Professional Shortage Areas (HPSA) vs non-Low Income/HPSA (44.8%/55.1%). Study Phase: Phase I/II (35.6%), Phase II (25.4%), Phase II/III (2.8%), Phase III (26.6%), and Phase IV (0.3%). Study sponsor: Industry (61.1%), Institutional (23.6%), National (14.8%), and Externally Peer Reviewed (0.3%). Most notably, the Asian enrollment (20.1%) and Hispanic enrollment (20.5%) exceeded demographic representation of Asians (17%, RR 1.18) and Hispanics (19%, RR 1.07) at CFCCC. Asians enrolled at significantly higher rates for lung and liver cancer, Hispanics for breast cancer, and Blacks for prostate cancer. Conclusions: Our results demonstrate that URM clinical trial enrollment, particularly among Asian and Hispanic populations, is feasible at an NCI-designated cancer center. Further research is necessary to investigate factors that influence clinical trial participation in the pursuit of equitable cancer care. Introduction Clinical trials play a unique role in cancer care, offering a glimpse into future therapies, while helping to redefine standard-of-care treatment 1 . The external validity of these trials relies on the representativeness of enrolled patients to real world populations 2 . However, trial population representativeness may vary due to differences in clinical and demographic characteristics, including but not limited to gender, race, medical comorbidities, and sexual orientation 2 . Thus, a lack of adequate representation of multiple populations, particularly underrepresented minorities in clinical trials, limits the generalizability of novel research findings and perpetuates health disparities. Diversity is necessary to not only expand the generalizability of novel therapeutics, but also to promote equity and build trust among communities who have been historically underrepresented 3 . These discrepancies highlight the importance of diverse representation in cancer clinical trial enrollment 3,4 . Despite strides to increase diversity in clinical trial enrollment, significant racial and ethnic disparities continue to persist, specifically in randomized cancer clinical trials 5,6 . Notably, Asian and Hispanic individuals are severely underrepresented compared to their census estimates, comprising as little as 1% and 6% respectively of all clinical trial enrollments 7 . This limits the broad generalizability of clinical trials and consequently the application of novel therapeutics for diverse populations due to race differences in drug/treatment responses 3,8 . From the NIH Revitalization Act over 30 years ago, to the more recent ASCO and ACCC’s Joint Research Statement on Increasing Racial and Ethnic Diversity, poor ethnic representation continues to persist despite multiple decade-long initiatives 6,9 . While reporting of ethnicity and race in clinical trials has improved, more than half of all clinical trials do not report race/ethnicity 7,10 . Furthermore, no federal mandates exist that require industry-funded clinical trials to report racial composition. To this end, only 17% of those industry-funded trial participants were non-White 11 , highlighting the continued challenges of minority recruitment in cancer clinical trials. While multiple studies have looked at specific cancer trial enrollment and found disparities in racial diversity 12–14 , to date, no study has examined ethnic representation in clinical trial enrollment over an extended period at an NCI designated cancer center in a minority-majority county, defined as a county with a minority population greater than 50 percent 15 . To date, only 12.5% of NCI cancer centers are in minority-majority counties 16 , further emphasizing the importance of understanding minority trial enrollment in these regions. Hence, we conducted a cross-sectional observational study to examine demographic characteristics in patients enrolled in cancer clinical trials at the UCI Chao Family Comprehensive Cancer Center (CFCCC). CFCCC is situated in Orange County (OC), CA, a minority-majority county, and can provide unique insights in this catchment area. We hypothesized CFCC would enroll minority populations at rates higher than national averages, partly due to a trial portfolio tailored to local patient populations and trial accessibility regardless of insurance type. Methods Clinical trial enrollment data was collected from 2015 to 2023 from IRB-approved interventional therapeutic cancer trials (as defined by the NCI) from the Chao Family Comprehensive Cancer Center (CFCCC) clinical trial management system (CTMS), Advarra OnCore 17 . OnCore is continuously updated and quality monitored by CFCCC’s clinical operations team and reported to the National Cancer Institute (NCI) on a regular basis. Non-therapeutic clinical trials were excluded from this study. Information about race/ethnicity (self-reported per NCI guidelines), sex, study stage, income, cancer type, and study sponsor were collected for further analysis through an anonymized data pull. Our use of the term underrepresented minority (URM) follows the NIH’s definition of URM as American Indian/Alaska Native, Asian, Black/African American, and Native Hawaiian/Pacific Islander identity for race, and Latino/Hispanic identity for ethnicity 18 . Due to exclusion of identifiable PHI, this study was deemed IRB-exempt by the UC Irvine Institutional Review Board. Demographics were compared to data provided by the NIH SEER reports in both OC and United States. The catchment area of CFCCC is defined as Orange County, California. For comparisons of discrete data, the chi squared statistical test was used. For comparisons of enrollment rates between different ethnicities/races and their general population, relative risk was calculated. The threshold for statistical significance was set at p=0.05. All analyses were performed in STATA-MP version 18. Results Between 2015-2023, 2315 subjects across 3 different UCI Health facilities were enrolled in clinical trials and included in the analysis. The cohort was 52% male (n=1196). Most patients were White (1539 [66.4%]), Asian (467 [20.1%]), or Black (57 [2.4%]), and 477 (20.5%) were Hispanic. One thousand and thirty-nine (44.8%) patients were from Low Income/Health Professional Shortage Areas (Table 1). The number of Hispanic patients under 60 years old was (307 [64.3%]) as opposed to (685 [37.9%]) for non-Hispanics. (Supplemental Table 1). Enrollment increased overall from the years 2016 to 2021 (Figure 1). From 2021 onward, there were decreases in enrollment for White patients, however, Hispanic and Asian patients maintained their increased enrollment (Figure 1). Regarding relative enrollment rates compared to the general patient population for different races and ethnicities, the rate of enrollment for Hispanic patients compared to the overall Hispanic patient population was higher than White patients (RR for Hispanic enrollment = 1.07, RR for White enrollment = 0.87). Additionally Asian patients were enrolled at higher rates compared to the general patient population as well (RR for Asian patient enrollment = 1.18). Out of the 46 different cancer types at CFCC, the ten most common enrolled in order were Breast (275 [12.9%]), Lung (248 [11.6%]), Blood/Bone Marrow (184 [8.6%]), Prostate (182 [8.6%]), Brain (165 [7.7%]), Bladder (142 [6.6%]), Liver (105 [4.9%]), Pancreas (91 [4.2%]), Ovary (90 [4.2%]), and Skin (81 [3.8%]). When evaluating the study stages for patient enrollment, 826 (35.6%) of patients were enrolled in Phase I/II, 590 (25.4%) were enrolled in Phase II, 65 (2.8%) were enrolled in Phase II/III, 618 (26.6%) were enrolled in Phase III, and 8 (0.3%) were enrolled in Phase IV trials (Table 1). Compared with national clinical trial enrollment, CFCC enrolled a higher proportion of Asian patients (20.1% vs 6.2%, Chi-Sq p < 0.001) (Table 2). There was lower enrollment of Black (2.4% vs 13.6%, Chi-Sq p < 0.001) and White (66.4% vs 75.4%, Chi-Sq p < 0.001) when compared to national data. There was also a lower percentage enrollment of Hispanic patients compared to Orange County as a whole (20.5% vs 34.0%, Chi-Sq p < 0.001) however, this was comparable to Hispanic patient enrollment rates nationally (20.5% vs 19.1%, N.S.). The clinical trials for certain cancer types disproportionately enrolled patients in specific race/ethnicity groups. Asian patients were enrolled at higher rates for clinical trials involving Liver cancer (42.8% vs 20.1% Asian enrollment overall, Chi-Sq p < 0.001), Lung and Bronchus cancers (41.5% vs 20.1%, Chi-Sq p < 0.001), and similarly for Breast (20.7% vs 20.1%, N.S.) and Bladder (19.0% vs 20.1%, N.S.) (Table 3A). There was 0% enrollment of Asian, American Indian, Black, Native Hawaiian, and Mixed-Race e patients in trials involving skin cancer (Table 3A). Black patients were more likely to be enrolled in Prostate cancer trials vs Black enrollment overall, (4.9% vs 2.4%, Chi-Sq p < 0.05) (Table 3A). White patients were more likely to be enrolled in Skin cancer trials vs White enrollment overall (92.5% vs 66.4%, Chi-Sq p < 0.05) (Table 3A). Hispanic patients were more likely to be enrolled in Breast cancer trials vs Hispanic enrollment overall (34.9% vs 20.5%, Chi-Sq p < 0.001) and less likely to be enrolled in Lung and Bronchus (9.6% vs 20.5%, Chi-Sq p < 0.001) and Bladder cancer trials (8.4% vs 20.5%, Chi-Sq p < 0.001) (Table 3B). The overall enrollment percentages for each race across the top ten cancer types are depicted in Figure 2. When evaluating enrollment rates of different races and ethnicities by trial phase, we found that Asians were enrolled at higher rates in Phase I/II trials vs Asian enrollment overall (24.4% vs 20.1%, Chi-Sq p < 0.01) (Table 4A). Additionally, Hispanic patients were enrolled at higher rates in phase II trials vs Hispanic enrollment overall (25.4% v 20.5%, Chi-Sq p < 0.01) (Table 4B). Race and ethnicity were otherwise not associated with the phase of trial enrollment in our data. When evaluating enrollment rates of different races and ethnic groups by trial sponsor type, we found that Asian patients were more likely to be enrolled in Industry sponsored trials vs Asian enrollment overall, (22.0% vs 20.1%, Chi-Sq p < 0.05) and that Black patients were less likely to be enrolled in institutional trials vs Black enrollment overall (1% vs 2.4%, Chi-Sq p < 0.05) (Table 5A). Hispanic patients were less likely to be enrolled in industry sponsored trials (18.8% vs 20.5% enrollment overall, Chi-Sq p < 0.05) (Table 5B). Discussion Summary of Key Results While there are 72 NCI designated cancer centers in the United States, only nine are located in minority-majority counties 16 . To our knowledge, this is the first cross-sectional study to present longitudinal patient data from an NCI-center located in a minority-majority county. Overall, we have found robust relative enrollment for specific minorities like Asian and Hispanic populations, and representative enrollment for Black populations. We have also found specific cancer trials that enrolled a disproportionate number of minorities, and certain trends in minority enrollment over time. Lastly, we found a high enrollment rate for individuals designated as Low Income/Health Professional Shortage Areas (LI/HPSA). Asian Recruitment Overall, recruitment of underrepresented minorities at our center was robust. Asian trial enrollment (20.1%) is roughly proportional to 2023 census data, mapping just below the 23.3% percent of Asian-Americans that reside in Orange County 7,19 . Compared to national census data, our cohort showed significantly higher recruitment of Asian populations (20.1% vs 6.2%). However, within Orange County, Asian-Americans are enrolled in clinical trials at an even higher rate than their representation at CFCCC (trial patients were 1.18 more likely to be Asian compared to patients in the general CFCC population). Robust Asian-American trial enrollment at CFCCC can be attributed to many factors, including a tailored clinical trial portfolio addressing high-incidence malignancies in this population (Supplemental Table 2). To this end, Orange County is home to the largest population of Vietnamese individuals outside of Vietnam, a population with relatively high rates of hepatitis B/C infection and increased risk for HCC 20 . Asian-Americans also experience a higher burden of stomach and nasopharyngeal cancers, well-represented in the CFCC trial portfolio 21,22 . Despite historic underrepresentation of Asians in cancer clinical trials to date 23,24 , these study findings highlight the feasibility Asian-American clinical trial enrollment. Hispanic Recruitment While our recruitment of Hispanic individuals (20.5% vs 19.1%) was comparable to the national average, it still trails the proportion of Hispanics living in OC 19 . However, the Hispanic population at CFCCC (and Orange County) is relatively young compared to non-Hispanic patients, with 64.3% of patients under 60, compared to 37.9% among non-Hispanic patients. When comparing the percentage of trial enrollees who were Hispanic with the percentage of cancer patients who were Hispanic, we found that our center over-enrolled Hispanic patients (trial patients were 1.07 more likely to be Hispanic compared to patients in the general CFCC population). This greatly differs from previous literature suggesting that Hispanic patients are historically underrepresented in cancer trials, with numbers trailing in the single digits 25,26 . Additionally, Hispanic patients are known to have lower insurance coverage rates 27 . As such, it follows that UCI’s status as a safety net hospital, defined by the National Institute of Medicine as a hospital that provides significant levels of healthcare to individuals with no health insurance or Medicaid, may have augmented minority trial enrollment by allowing these individuals to enroll in clinical trials irrespective of ability to pay 28 . While further research should be conducted to identify and overcome region-specific barriers to minority trial participation, our data suggests that tailoring of trials toward Hispanic patients may yield strong subsequent trial enrollment despite these barriers. Black Recruitment The proportion of Black individuals at CFCCC roughly matches the Black population in OC (2.4% vs 2.3% respectively). While Blacks represent a small portion of OC demographics, their representation in clinical trials is crucial. However, given that Black patients make up only a small percentage of Orange County’s population, it is difficult to draw meaningful conclusions from Black clinical trial enrollment at CFCC. To date, Black populations in the United States continue to be underrepresented in cancer clinical trials 29 . This is of particular concern, given that Blacks continue to have low survival rates across most diagnosed cancers in the United States 30 . Low minority enrollment in clinical trials likely stems from a myriad of structural factors, including but not limited to lack of available trials suitable for a patient’s cancer type, narrow inclusion criteria, and insurance coverage 31,32 . Historical events, including the Tuskegee Syphilis study, may have contributed to medical mistrust in Black communities, creating further barriers to trial enrollment. Despite these challenges, our results represent a step forward in obtaining representative enrollment of Black individuals in cancer clinical trials. Enrollment Rates over Time We found that since 2015, White enrollment steadily decreased while Asian enrollment steadily increased. There was a decrease in Asian enrollment between 2020 and 2021, potentially owing to the impact of the COVID-19 pandemic 33 . While Hispanic enrollment at CFCCC steadily increased from 2015 to 2019, it has remained largely unchanged from 2019 onwards. While cancer clinical trial enrollment among minority populations in Orange County have remained relatively stagnant in recent years, these trends are not consistent with national data indicative of a widening diversity gap in cancer clinical trial enrollment during the COVID-19 pandemic 34 . Additional research is needed to further characterize these trends. Cancer-Specific Enrollment Rates Clinical trial enrollment by race varied significantly by cancer type in our cohort. In our cohort, Asian Americans were enrolled at significantly higher rates in liver and lung cancer clinical trials compared to non-Hispanic Whites, reflective of the high incidence of hepatocellular and lung carcinoma among Asian-Americans 21,22 . Of note, Hispanic patients enrolled at higher rates than non-Hispanic Whites for breast cancer, despite experiencing significantly lower rates of breast cancer compared to non-Hispanic Whites 35 . Black men are disproportionately affected by prostate cancer, and Black individuals participated in Prostate cancer trials at CFCCC at significantly higher rates than expected 36 . Of note, non-white patients enrolled at significantly lower rates in skin cancer clinical trials, which can be partially attributed to lower incidence of skin cancer in these populations 37 . Overall, minority participation in tumor specific trials at CFCCC was in line with their incidence in these respective populations, representing a significant step forward in cancer clinical trial representation compared to prior national trends 35,38 . Trial Phase Race-based differences in trial enrollment extended to trial phase as well with Asian-Americans and Hispanics more likely to enroll in early phase trials. Historically, strict eligibility criteria and other barriers have prevented minorities from participating in earlier studies, and many benefits can be derived from having more diverse early phase trials 39 . Asians are known to have higher Phase I enrollment rates in the literature, and our results corroborate this finding 25 . Conversely, Hispanics are historically underrepresented in Phase II/ Phase III trials 40 ; our distinct findings indicate the possibility of growing Hispanic population recruitment in early phase trials (like Phase I and II). Minority recruitment in early phase trials has several benefits, namely providing valuable safety data on the side effect profiles of novel chemotherapeutics in minority populations. This is of particular importance, given that ethnic variation in allelic expression may lead to differences in pharmacokinetics and subsequently tolerability among various minority groups 41,42 . Our results highlight the feasibility of recruiting historically underrepresented minorities in early phase clinical trials, representing a positive step toward equity in cancer care. Participation by Income Lastly, a significant proportion of our trial participants (44.8%) were designated as Low Income/Health Professional Shortage Areas (LI/HPSA) individuals, defined as a population or geographic area with lacking healthcare professionals in primary care, health care, and dental care 43 . Prior literature suggests that low-income individuals are less likely to participate in cancer clinical trials due to financial strain or be offered the opportunity to enroll in clinical trials 44–46 . In stark contrast, the high percentage of individuals from these areas suggest that it is possible to achieve equitable rates of enrollment regardless of income level. This may be partially explained by UC Irvine’s designation as a safety net hospital, which may have facilitated enrollment for low-income individuals without fear of financial expenditures. Practical Implications and Strategies The practical implications of this study stem from the strategies utilized to incorporate the needs of the catchment area into an accessible, tailored trial portfolio targeted toward URM populations. At CFCCC, annual reviews are performed of patient demographic data, as well as statistics on cancer prevalence and stage. Disease-oriented teams integrate this data into meetings intended to assess each therapeutic trial’s potential for accrual, prioritizing those that address existing gaps in cancer care, particularly for URM populations. This allows for a data-driven approach to trial selection capable of addressing the unmet needs of our catchment area (Figure 3). For example, given the high incidence of gastric cancer and HCC in our catchment area, efforts are made to enroll patients in trials specifically targeting these malignancies. This approach aligns with one of the core mandates of NCI-designated cancer centers—to address the unique healthcare needs of the communities they serve. By prioritizing clinical trials that reflect local disease burdens rather than solely focusing on scientific novelty, we can more effectively bridge disparities in cancer research participation, particularly for our Asian and Hispanic populations. In addition to trial selection, ensuring accessibility for underinsured and underserved populations was key to achieving representative enrollment. Accepting public insurance programs, such as CalOptima and Medi-Cal, has reduced financial barriers and expanded trial participation among low-income patients, and reflected in nearly half our patients designated as LI/HPSA. Additionally, the integration of the Office of Community Outreach and Engagement (COE) from the early stages of trial design has ensured that study protocols align with the linguistic, cultural, and logistical needs of the catchment area. For example, simplified informed consent forms, available in multiple languages, has enhanced comprehension and participation for non-English speaking Asian and Hispanic patients. Additionally, in-clinic resources such as iPads with translation services and in-person interpreters for commonly spoken languages, including Spanish and Vietnamese, has facilitated patient-provider communication. Overall, on a broader scale, participation in data-sharing initiatives with other NCI-designated cancer centers has fostered the exchange of best practices, further refining strategies for improving minority representation in clinical trials. These concerted efforts contribute to a more inclusive research environment, ultimately enhancing the relevance and availability of novel cancer treatments to diverse populations. Limitations This study has some limitations. For one, as a single-center study, our findings may not be generalizable outside of the CFCCC catchment area. Additionally, demographic data was not collected on gender identity, sexual orientation, primary language, factors that could provide further insight into trial enrollment among our patient population. Additionally, given that this registry data was directly extracted from the CFCCC database, we do not have access to information on patient income, insurance coverage, distance traveled, and other granular data. Lastly, as a quantitative study, we were unable to capture qualitative patient data regarding incentives and barriers to clinical trial enrollment. Conclusion Despite the presence of numerous barriers to URM clinical trial enrollment, our findings suggest that minority populations seen at CFCC are equally or more likely to enroll in clinical trials compared to White participants at our cancer center when trial portfolio and patient access is tailored to the population at hand. Our results, specifically among Asian and Hispanic populations, demonstrate that robust minority enrollment in clinical trials is feasible at an NCI cancer center. Additionally, increased diversity in trial data may facilitate development of personalized treatment plans and novel therapeutics that account for and target genetic differences among subpopulations to bridge cancer care disparities 47–49 . Ultimately, diverse trial enrollment holds great importance for working toward equitable outcomes and personalized therapies in cancer care. Further research is necessary to investigate factors that influence clinical trial participation in the pursuit of increased racial representation and equitable cancer care. Conflicts of Interest Dr. Dayyani has served on advisory boards, speaker bureau or consulted with Astellas, Astrazeneca, Eisai, Exelixis, Ipsen, Jazz, Servier, Sirtex and Takeda. Dr. Valerin has served on speaker bureau and consulted with Astrazeneca and Tempus, respectively. Other authors have no conflicts of interest to disclose. Funding No specific funding or grant was received for this research. Acknowledgements We would like to thank Lexington Tredway for his support in the graphic design of the figures. Data Availability Statement In accordance with the FAIR principles required for data access, the authors confirm that the data supporting these findings will be made publicly available through direct data pulled from the Chao Family Comprehensive Cancer Center (CFCCC) clinical trial management system (CTMS), Advarra OnCore via an appropriate text format. Sources 1. Fountzilas, E., Tsimberidou, A. M., Vo, H. H. & Kurzrock, R. Clinical trial design in the era of precision medicine. Genome Med. 14 , 101 (2022).2. Tan, Y. Y. et al. Comparing clinical trial population representativeness to real-world populations: an external validity analysis encompassing 43 895 trials and 5 685 738 individuals across 989 unique drugs and 286 conditions in England. Lancet Healthy Longev. 3 , e674–e689 (2022).3. Schwartz, A. L., Alsan, M., Morris, A. A. & Halpern, S. D. 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Keywords cancer representation clinical trial enrollment demographics disparities diversity representation Authors Affiliations Frank Lee 0000-0002-7217-1779 University of California Irvine School of Medicine View all articles by this author Aditya Mahadevan 0000-0002-2834-5487 University of California San Francisco View all articles by this author Armon Azizi University of California San Diego View all articles by this author Jennifer Valerin Chao Family Comprehensive Cancer Center View all articles by this author Nataliya Mar Chao Family Comprehensive Cancer Center View all articles by this author Deepa Jeyakumar Chao Family Comprehensive Cancer Center View all articles by this author Farshid Dayyani [email protected] Chao Family Comprehensive Cancer Center View all articles by this author Metrics & Citations Metrics Article Usage 193 views 119 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Frank Lee, Aditya Mahadevan, Armon Azizi, et al. Adequate Underrepresented Minority Representation in Cancer Trials: Evidence from an NCI-Designated Center in a Minority County. Authorea . 21 April 2025. DOI: https://doi.org/10.22541/au.174524077.78834283/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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