ArticleJournal of racial and ethnic health disparities2026
Who Gets Left Out of Precision Oncology? Real-World Driver Mutation Expression Patterns and Therapeutic Eligibility in a Diverse Single-Center Early-Stage Lung Adenocarcinoma Cohort.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPrecision oncology in non-small cell lung cancer (NSCLC) is driven by identification of actionable genomic alterations; however, trials establishing these paradigms often underrepresent racial/ethnic minorities and report mutations without comprehensive subtype characterization. We aim to define real-world biomarker patterns, including subtype distributions, across a diverse lung adenocarcinoma cohort.
methodsA retrospective analysis of patients undergoing surgical resection for lung adenocarcinoma (2021-2025) at a single urban academic center was performed. Patients with available next-generation sequencing (NGS) were included. EGFR mutations were categorized as typical versus atypical (PACC variants, exon 20 insertions, T790M, non-L858R exon 21 alterations), and KRAS mutations as G12C versus non-G12C.
resultsOf 292 patients, 40.8% (n = 119) were non-Hispanic Black, 28.1% (n = 82) Hispanic, 16.1% (n = 47) non-Hispanic White, 6.2% (n = 18) Asian, and 8.9% (n = 26) other/unknown. Hispanic ethnicity was independently associated with EGFR positivity (aOR 3.88, 95% CI 1.34-11.20). Among EGFR-positive tumors, 26% were atypical, with numerically higher proportions in Black (37%) and Hispanic (27%) patients as compared with White (14%) and Asian (0%) patients. Among all KRAS mutations, 58% (n = 65) were non-G12C variants, which were not independently associated with any racial/ethnic subgroup.
conclusionIn a diverse cohort, atypical EGFR and non-G12C KRAS mutations, including subtypes with limited targeted treatment options, were common and, for EGFR, appeared numerically more common in Black and Hispanic patients. These findings highlight a potential structural gap in precision oncology, in which underrepresented populations may be disproportionately affected. Comprehensive NGS and inclusive trial design are important in ensuring equitable access to biomarker-driven therapies.
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