Actionable Alterations in NSCLC Detected at Varying Frequencies Across Racial Groups

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Minority underrepresentation remains a problem in clinical trials despite the passage of the National Institutes of Health Revitalization Act by the US Congress in 1993.1 This act was passed to increase minority group inclusion in clinical trials, but minority racial and ethnic groups continue to be underrepresented.1 This skews medical data, resulting in minority populations having inadequate data on efficacy and safety of therapies and engendering a biased foundation of biological variants that is propagated forward in new research.1

Lung cancer is a leading cause of cancer-related death in the United States with non–small-cell lung cancer (NSCLC) representing 85% of all lung cancer cases.2 Black people have a higher incidence rate of lung cancer than White people and experience challenges in receiving lung cancer services.2 These challenges include providers and services located outside the community, transportation issues, lack of support services or resources, lack of information about lung cancer, and fear and mistrust of the medical system.2 A lack of coordinated effort to mitigate lung cancer treatment challenges also exists in many minority communities.2 These challenges and the lack of data on the effect of therapies in minority populations affect future cancer research, in particular, molecular and biomarker aspects of precision oncology in non-White patients.1

To better understand the real-world mutational frequencies in Asian, Black, and White patients with cancer, a study was conducted using clinic-genomic data from community oncology clinics from patients with known race and next-generation sequencing from September 2015 to November 2021. Asian patients were not evaluated in all cancer cases due to low patient numbers.

A total of 18,399 patients were included in this study: 177 Asian, 1319 Black, and 16,903 White patients. NSCLC was the most common tumor type found, followed by colorectal cancer, breast cancer, and prostrate cancer. NSCLC was found in 33% of Asian patients, 27% of Black patients, and 30% of White patients. Among Asian patients with NSCLC, 43% had EGFR mutation, 5% had KRAS G12C mutation, and 5% had ALK fusion. Among Black patients with NSCLC, KRAS G12C was identified in 11%, EGFR mutation in 9%, and ALK fusion in 1%. Among White patients with NSCLC, 9% had EGFR mutation, 9% had KRAS G12C mutation, and 1% had ALK fusion.


  1. Turner BE, Steinberg JR, Weeks BT, Rodriguez F, Cullen MR. Race/ethnicity reporting and representation in US clinical trials: a cohort study. Lancet Reg Health Am. 2022;11:100252.
  2. Coughlin SS, Matthews-Juarez P, Juarez PD, Melton CE, King M. Opportunities to address lung cancer disparities among African Americans. Cancer Med. 2014;3(6):1467-1476.

Source: Sturgill E, Correia J, Schumacher C, et al. Variable detection of actionable alterations across racial groups and association with testing patterns. J Clin Oncol. 2022;40(16 suppl):3116-3116.

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