ideasIdea
Fix the neutrophil count rule that excludes many people of African ancestry
Many healthy people of African descent have naturally lower white-cell counts because of a common genetic variant. Trials use a single cut-off that wrongly labels them unfit, so they are turned away. The rule should be adjusted for this variant.
The Duffy-null phenotype (ACKR1 rs2814778 CC), carried by a majority of people of West African ancestry, is associated with lower baseline neutrophil counts without increased infection risk. Protocols would use Duffy-status-specific absolute neutrophil count thresholds (or exclude on infection history rather than ANC alone), and dose-modification rules for neutropenia would be reinterpreted accordingly. Duffy status is a cheap blood test.
Hypothesis
Adopting Duffy-aware ANC thresholds will remove a leading cause of screen failure among Black patients in oncology trials and will not increase febrile neutropenia among those enrolled under the adjusted threshold.
Rationale
Retrospective analyses attribute a substantial share of Black patients' trial ineligibility and chemotherapy dose reductions to the standard ANC cut-off, and the Duffy-null association with benign neutropenia is well established in haematology.
What would test it
A sponsor adopts Duffy-aware thresholds across its solid-tumour trials for two years; compare Black patient screen-failure rates and febrile neutropenia among those newly eligible against prior protocols.
Maturity
early clinical
Who has to act
industry
Cost to try
Small (under $1M)
Years to first evidence
1
Bottlenecks it attacks
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.