Analysis Reveals Survival Gap, Racial Disparities in Ovarian Cancer Research

A cohort study published in JAMA Network Open that analyzed decades of data from major phase 3 ovarian cancer trials found a stark lack of diversity among patients: More than 91% of patients were White, leaving Black and Asian patients significantly underrepresented. Notably, Black patients faced a 30% higher risk of death and a median survival rate nearly a year shorter than White patients.¹

Out of 1903 evaluable patients across 4 phase 3 trials, representation was heavily skewed up front; 91.8% of participants were White, 6.4% were Black, and 1.8% were Asian.

Further, regarding survival, the study found a significant difference in overall survival (OS) by race. Black patients had a median OS of 36.8 months, compared with 48.4 months for White patients and 50.9 months for Asian patients.

Interestingly, progression-free survival (PFS)—the time before the cancer worsens—was statistically similar across all groups (range, 18.0-19.7 months). This suggests that although the disease responded similarly to initial treatment across races, long-term survival outcomes diverged sharply for Black patients. These findings raise urgent questions about systemic barriers to enrollment and the biological or socioeconomic factors that may mediate long-term survival.

In an interview with Targeted Oncology, Alex Francoeur, MD, a gynecologic oncology fellow at the University of California Irvine School of Medicine and one of the study’s authors, broke down the reasons behind the research and the possible factors underlying these disparities.

Targeted Oncology: What was the rationale behind the study?

Alex Francoeur, MD: This was a study that came out of trying to understand why we see a lot of the disparities we see in our patients with ovarian cancer. There are tons of studies that have been done on retrospective, large data sets and other kinds of popular data looking at outcomes by race and ethnicity. In general, patients who are Black or Hispanic generally [have worse outcomes] in terms of [PFS] and [OS], in terms of treatment for ovarian cancer.

What were the key findings?

I think one of the questions is [to ask] why and how we can mitigate these disparities that we've identified. And so, this study aimed to look at it in a more controlled setting. We got several data sets from NRG [Oncology] and GOG [Gynecologic Oncology Group], and these basically were randomized controlled phase 3 trials. We looked at, instead of just the outcomes by treatment arm, patient outcomes by race and ethnicity to see whether when patients are on clinical trial there is any difference in their outcomes based on that.

Even though the treatment arms are different when you look at each trial, race and ethnicity are very well balanced, and so we included both the treatment and the control arms in our study to give ourselves a more robust sample size, especially because the large majority of these patients are White. We included a slightly larger population, and the one-liner of what we found was, when you look at [PFS], there was no significant difference among the 3 groups we looked at, which were White, Black, and Asian. These trials were done in the 1990s.

And then when you look at [OS], what you do see is a bigger separation in the curves. And so there is a statistically significant difference in [OS] when you compare the White patients with the Black patients, and the rationale or reasoning or hypothesis that we drew from this is that when patients are on trial, they are in a very controlled microcosm.

There are specific benchmarks they have to meet. They have to go in for very strict imaging and blood work, because the trial coordinators and drug companies are monitoring that very closely. And so, the [PFS] data point captures how the patients did on trial, and then obviously, once you progress, you come off trial. Then that [OS] data point gives us a picture of how the patient does off trial.

What was the overall conclusion?

I think this highlighted where we see a separation and disparities in terms of patient outcomes, looking at these 2 different time points. What we concluded is that when patients are put on a trial, everyone kind of has an equal playing field. And then when they come off trial, we see potential disparities in outcomes.

REFERENCE

1. Johnson C, Francoeur A, Grewal A, et al. Trial enrollment and survival disparities among patients with advanced epithelial ovarian cancer. JAMA Netw Open. October 22, 2025. Accessed January 30, 2026. 2025;8;(10):e2538648. doi:10.1001/jamanetworkopen.2025.38648