Hala Borno, MD, Resident Alum : Ensuring clinical trials serve patients of color

As a war refugee, a Palestinian immigrant, and now an oncologist, Hala Borno knows that access to health care can determine whether a patient survives a life-threatening illness – or not.

Cancer outcomes correlate with race and ethnicity partly because clinical drug trials fail to enroll diverse patients – a situation that will only worsen in the era of precision medicine. “It matters who is tested,” she notes.

Borno has witnessed inequities since she was a young child fleeing Kuwait with her family during the first Gulf War. When her grandfather was diagnosed with cancer, she watched her mother struggle to navigate the U.S. health system. As Borno moved through medical training, everywhere she looked she saw barriers to care.

When she realized that racial imbalances have long plagued clinical drug trials – crucial to discovering whether medications are safe and effective, yet serving a fraction of patients who could benefit – Borno had to act.

In 2021, with guidance from UCSF Innovation Ventures, Borno created Trial Library to bring equity to oncology clinical trials; in August, the company emerged from stealth mode, fueled by $5 million from angel investors attracted by her experience, dedication, and approach.

As a practicing oncologist, Borno knows most patients trust their own doctor: 77% enroll in trials on their doctor’s recommendation. But nearly all cancer patients are treated in community practices – places not commonly involved in clinical trials. So Borno reached out to over 800 oncologists across California to identify the barriers and worked with the drug companies sponsoring trials to overcome them.

“Our model is very thoughtful,” she explains. “What are the barriers for the medical provider? For the patient?”

Knowing it must be worth doctors’ time to prescreen patients for trials, Borno offers doctors reimbursement from trial sponsors – a key innovation, it turns out. She addresses patients’ uncertainty by providing navigators to help people enroll. Navigators also evaluate patients’ “social determinants of health” to understand barriers experienced by patients from diverse backgrounds.

Her advice to would-be entrepreneurs? “Listen to that hum in the back of your mind. If it doesn’t go away, do something.”

Now that Trial Library has launched navigation services for cancer trials, Borno plans to tackle racial inequities in trials for other diseases. “Once we fix it in oncology,” she promises, “we can go beyond.”

– Katherine Conrad for UCSF Magazine