Why Equitable Trial Access is the Next Frontier in Ovarian Cancer Care

In the landscape of gynecologic oncology, understanding the intersection of clinical outcomes and patient demographics is essential to achieving true health equity. While disparities in cancer care are well-documented, an ancillary analysis of data published in JAMA Network Open¹ is shedding light on how these disparities manifest—or disappear—within the controlled environment of a clinical trial.

By pooling data from 4 separate study protocols involving patients with stage 3 and 4 epithelial ovarian cancer, researchers utilized Cox proportional hazards modeling to examine the impact of race and ethnicity on 2 critical end points: overall survival (OS) and progression-free survival (PFS).

The findings offer a powerful argument for "equitable enrollment." The study reveals that when patients of diverse backgrounds are enrolled in randomized phase 3 trials, the traditional gaps in clinical outcomes begin to close, suggesting that standardized, high-quality care can act as a great equalizer. However, the data also point to a lingering mystery: a significant disparity remains in the timeframe between disease progression and death, raising urgent questions about social determinants of health and access to care outside the trial setting.

Additional research in this space suggests that biological or treatment-delivery differences—such as higher toxicity rates in Black patients—may be the missing link explaining why long-term survival still lags behind.²

Following part 1 of 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 study’s design and methodology?

Alex Francoeur, MD: This was an ancillary data analysis from randomized control trial data from the [Gynecologic Oncology Group; GOG]. We included 4 study protocols, and it included all patients who had stage 3 or 4 epithelial ovarian cancer. We looked at patient outcomes in these trials based on race and ethnicity, and our 2 primary end points were [OS] and [PFS]. We used Cox proportional hazards and adjusted for confounders in our model to look at those end points.

What were some of the implications or major takeaways that you think oncologists should know based on this study?

The biggest takeaway for me is that when you enroll people on a randomized phase 3 trial, we see no difference in outcomes based on race and ethnicity, and I think this highlights the importance of including a diverse population on clinical trials. I think further research is needed to look at what is happening in that progression between progression and death that is driving this disparity that we see in that timeframe.

What are some of the next steps in this line of research?

Looking at why we're seeing that disparity between those 2 time points would be an area of further research to try and understand better what could be driving that [OS] difference between the progression and survival. Is it comorbidities? Is it substandard care? Is it access to care? Are there social determinants of health? I think when you get these datasets, they have limited data on certain things. So we weren't really able to delve into that, but I think that would be a next step.

How can “equitable enrollment” be achieved? What can community oncologists do to achieve that?

I think that a lot of times, unfortunately, clinical trials are housed at large academic centers that maybe don't necessarily take care of the actual patient population that exists in that region. That's where it's important for these trials to be accessible to a diverse population, and so creating more ways that smaller community hospitals or regional hospitals can still safely enroll patients on trial, I think, is really important.

There's also a lot of work done that shows that the inclusion and exclusion criteria for a lot of these trials can be restrictive. [For example], if patients have kidney disease or certain comorbidities, HIV, or even hepatitis or liver disease, they may be excluded from the trial. I think encouraging or urging the organizations like NRG or GOG or the drug companies that fund these trials to try and make the trials more inclusive to a broader population, because there's some data [suggesting] that minority populations are more likely to be excluded based on those enrollment criteria.

My take-home point that I would emphasize is that we need to try and expand our representation in trials and that this is a study that shows that when you include patients on trials, they do equally well, and it mitigates disparities seen in other studies.

REFERENCES

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

2.Bandera E, Lee V, Kavecansky J, et al. Racial and ethnic disparities in severe chemotherapy-related toxicities among women with ovarian cancer: Findings from the KPROCS cohort study. JCO Oncol Pract 21, 245(2025). Volume 21, Number 10_suppl. doi: 10.1200/OP.2025.21.10_suppl.245