Addressing social and economic disparities in triple-negative breast cancer immunotherapy: a US-focused review

Study researchers examined social and economic differences in the use of immunotherapy for treating triple-negative breast cancer (TNBC) in the United States. TNBC is a particularly aggressive form of breast cancer with limited treatment options. The study aimed to identify barriers that prevent access to immune checkpoint inhibitors (ICIs), a type of immunotherapy, among different racial, socioeconomic, and geographic groups.

This research examines the unequal differences in access to treatments for TNBC, which affect some communities at higher rates than others. Understanding these differences is crucial for healthcare providers, policymakers, and the academic community to develop strategies improve access to effective treatments for all patients. By identifying these gaps in care, the study aims to improve health outcomes and survival rates for groups that have not been adequately represented in clinical trials.

The researchers conducted a narrative review of literature from 2000 to 2025, using databases including PubMed, MEDLINE, and Google Scholar. They focused on studies involving clinical trials, observational cohorts, and reviews that discussed trial participation, biomarker testing, treatment initiation, adherence, and outcomes. The review paid particular attention to differences in outcomes and access related to race, ethnicity, insurance status, and geographic location.

The study found that ICIs, or inhibitors, improve survival rates for some TNBC patients. However, Black, Hispanic, and rural patients are often not included in clinical trials, limiting the applicability of trial results to these groups. Gaps in biomarker testing, which identifies substances that indicate the presence of cancer, along with issues in insurance coverage and access to specialized cancer centers, worsen these differences in outcomes. Despite these challenges, when patients with limited access to care receive ICIs, their outcomes are similar to those of patients with greater access to specialized care.

The findings suggest that addressing social and economic barriers could lead to more consistent health outcomes for TNBC patients. Increasing clinical trial participation, standardizing biomarker testing, and broadening insurance coverage are important steps. These measures could expand the access to immunotherapy and improve survival rates across all patient groups.

The authors recommend future research to combine precision oncology, which tailors treatment based on individual genetic information, with approaches that account for social and economic factors influencing patient access and outcomes. This could help expand the reach of new immunotherapies to patients with limited access to healthcare. Addressing both biological factors and barriers in the healthcare system is essential for improving outcomes in TNBC treatment.

Yale University provided funding and support for the research.