Geographic and demographic differences in genomic testing and outcomes in pancreatic cancer.

Abstract

e22629 Background: National Comprehensive Cancer Network (NCCN) guidelines recommend universal tumor genomic profiling for patients with pancreatic ductal adenocarcinoma (PDAC) to identify actionable alterations and guide treatment. Real-world implementation of next-generation sequencing (NGS) may vary by geographic and demographic factors, potentially contributing to disparities in treatment delivery and outcomes. Methods: We conducted a retrospective cohort study of patients with PDAC treated at a single academic center serving the Washington, DC–Maryland–Virginia (DMV) region. Clinical, demographic, treatment, and outcome data were abstracted from the medical record. Residential zip codes were categorized as Washington, DC or suburban Maryland/Virginia. Receipt and timing of tumor genomic profiling, treatment intensity, and overall survival (OS) were evaluated descriptively by geographic location and patient demographics. Results: Twenty-two patients with PDAC were identified. Median age was 69 years, 55% were male, and 64% were Black. Sixteen patients resided in Washington, DC and six in suburban Maryland or Virginia. Tumor genomic profiling was performed in 93% of DC residents and 100% of suburban residents. Suburban residents were more likely to receive multi-agent chemotherapy and undergo curative-intent resection. Median OS was approximately 14 months among DC residents and 23 months among suburban residents. Receipt and timing of tumor genomic profiling varied by geographic and demographic subgroups, including race, age, and treatment intensity. Common genomic alterations, including KRAS and TP53 , did not differ across demographic groups. Conclusions: In this real-world cohort, implementation of tumor genomic profiling and treatment intensity for PDAC varied by geographic location and patient demographics and was associated with differences in survival outcomes. These findings suggest that geographic factors, which may reflect underlying differences in access to care, influence delivery of guideline-concordant precision oncology and highlight the need for strategies to promote equitable delivery of tumor genomic profiling. Demographics, treatments, and outcomes by geographic location. Washington, DC (n=16) MD/VA Suburbs (n=6) Median age, years 67 74 Male sex, n (%) 8 (50) 4 (67) Black, n (%) 9 (56) 5 (83) Tumor genomic profiling performed, n (%) 15 (93) 6 (100) Received multi-agent chemotherapy, n (%) 13 (81) 6 (100) Curative-intent resection, n (%) 4 (25) 4 (67) Median OS a , months ~14 ~23 Common genomic alterations KRAS, TP53 KRAS, TP53 a. Overall survival.