Ancestral Differences in Anticancer Treatment Efficacy and Their Underlying Genomic and Molecular Alterations

Abstract Systematic multiomic analysis has revealed ancestry-dependent molecular alterations, but their impact on the efficacy of anticancer treatment is yet largely unknown. In this study, we analyzed clinical trials from ClinicalTrials.gov and found that only 8,779/102,721 (8.5%) oncology clinical trials posted information on enrollment by race/ethnicity. The underrepresentation of non-White populations suggests that it remains challenging to determine differences in the efficacy of antitumor treatments among different racial groups. Through a comprehensive analysis of clinically actionable genes, imputed drug responses, and immune features, we identified potential differences in treatment responses to targeted therapy, chemotherapy, and immunotherapy between different ancestral populations. Further analysis of multiple independent cohorts confirmed some of our key findings. Such potential ancestral effects are also identified in response to emerging new treatments like chimeric antigen receptor T-cell therapy and proteolysis-targeting chimeras. These findings are made publicly available in a comprehensive web portal, Ancestral Differences of Efficacy in Cancers (https://hanlaboratory.com/ADEC), to facilitate their further investigation. Significance: Our study charts a global landscape of ancestry-associated differences in therapeutic efficacy, highlighting the importance of considering ancestry in anticancer therapies.