The gap: Recognizing the inequities in oncology research and clinical practice guidelines—An analysis of clinical guidelines in multiple myeloma.

Abstract

e23213 Background: Despite significant efforts to address inequities in oncology research, and American Society of Clinical Oncology’s (ASCO) Clinical Practice Guidelines for Hematologic Malignancies in Multiple Myeloma (MM) being updated as of 2026, a critical gap remains. These guidelines aim to promote uniformity of care for all patients with MM, yet there is still an imperative need for additional, disease-specific guidelines in hematologic malignancies, as well as for clinical research that more accurately reflects the diversity of patient epidemiology. Representative studies must be done to reflect the racial prevalence of MM, as more than twice the incidence is found in Black individuals than White Individuals (Kanapuru et al., 2022). The DRIVE ranking score assesses representation in clinical trials based on disease epidemiology (Birhiray & Birhiray, 2023). A DRIVE Score of 3 or higher is the benchmark for clinical excellence and relevance based on racial representation. An analysis of the new ASCO guidelines using the DRIVE score evaluates the generalizability and transportability of the referenced clinical trials. Methods: Following the publication of “Treatment of Multiple Myeloma: ASCO–Ontario Health (Cancer Care Ontario) Living Guideline the authors analyzed the clinical trials that were used (Mikhael et al., 2026). 70 studies were utilized, with 47 studies involving adult human participants in the United States. These studies were reviewed using the National Cancer Institute (NCI) clinical trial results section and related articles. Results: Twenty-three studies were excluded due to all testing locations being outside of the U.S. The remaining 47 studies received the following DRIVE scores: 10 received a 0x, 6 received a 0, 4 received a 0*, 18 received a 1, 0 received a 2, 7 received a 3, and no studies scored a 4 or 5. Two additional studies are still in progress and were not scored. Conclusions: ASCO, as a leader in oncology research and clinical practice, must ensure transparency and accessibility for patients, clinicians, and scientists while promoting reliable and inclusive data. This analysis reveals a significant gap in utilizing population-representative studies, and a lack of representative guidelines for MM and perhaps other malignancies. The guidelines should utilize trials that are representative of patient populations, or use a subanalysis of the data to make generalizable recommendations for all patient groups. Accurate representation must be utilized in all clinical trials in order to reflect the patient population. By prioritizing diversity in clinical research, ASCO can strengthen the evidentiary foundation of its guidelines while reducing disparities and improving outcomes for patients and clinicians. These guidelines cannot truly uniformize care while being based on unrepresentative data.