Molecular profiling in NSCLC: Uncovering disparities and advancing health equity.

Abstract

e22599 Background: Non-small cell lung cancer (NSCLC) comprises 85% of lung cancer cases, including squamous-cell carcinoma, adenocarcinoma, and large-cell carcinoma. Advances in molecular testing have driven progress in targeted therapies and immunotherapy. However, data on molecular testing across racial groups remain limited due to underrepresentation in clinical trials, variability in testing availability, and socioeconomic barriers. This study examines mutation patterns in NSCLC across ethnic groups to better inform oncology care. Methods: We retrospectively analyzed the genetic profiles of 97 NSCLC patients at our academic Hematology-Oncology clinic. Demographic data, disease stage, and molecular profiles (mutations and PD-L1 expression) were collected. Mutations studied included KRAS, EGFR, ALK, PTEN, BRCA, and others (NF1, TP53, NRAS, ATM, MSS, STK11). Patients self-identified as White, Latino/Native American, Black/African Ancestry, or Asian. Descriptive statistics summarized findings, with trends analyzed by ethnicity. Results: Among 97 patients (41 White, 34 Latino/Native American, 14 Black, 7 Asian, 1 non-responder), 34 (35.1%) exhibited PD-L1 expression, suggesting potential for immune checkpoint inhibitors. PD-L1 was observed in 41.2% of Latino, 34.1% of White, and 21.4% of Black patients. The cohort's average age was 64.5, with Latino patients being the youngest at 62.3 years. Advanced disease (Stage III/IV) was most prevalent in Black (92.3%) and Latino (85.3%) patients, compared to White (82.9%) and Asian (71.4%) patients. Mutation prevalence included KRAS (4.1%), PTEN deletions (6.2%), EGFR (12.4%), ALK (9.3%), and BRCA (1%), with co-occurring mutations highlighting NSCLC’s molecular complexity. While mutation frequencies by ethnicity lacked statistical significance, observed trends align with prior evidence, emphasizing the need for population-specific research. The data suggest PD-L1 expression could be a therapeutic target across racial groups. Disparities in disease stage and age distribution highlight the urgent need for equitable access to early diagnosis and care. Conclusions: This study underscores the importance of understanding molecular and demographic characteristics of NSCLC in underrepresented populations. While mutation frequencies did not reach statistical significance, trends in age and advanced-stage diagnoses highlight disparities requiring further investigation. The higher prevalence of advanced disease in Latino and Black patients suggests delays in diagnosis and access to care, emphasizing the need for improved screening and equitable healthcare delivery. These findings support the integration of genomic profiling and tailored interventions to address disparities and improve outcomes. Further studies are needed to confirm these trends in precision oncology across racial and ethnic groups.