Racial disparities in cancer care was a focus of several studies presented at the 2021 ASCO Annual Meeting. Among these studies, one study wanted to see if there were any differences in the rate of biomarker testing (that look for genetic mutations and other genomic alterations), as well as enrollment in clinical trials among black and white patients with lung cancer.
The results of this study showed that black patients with lung cancer are significantly less likely to undergo next-generation sequencing (or NGS) testing to identify genomic biomarkers compared with white patients. These findings were presented at the meeting by lead researcher Debora S. Bruno, MD, Assistant Professor of Medicine at Case Comprehensive Cancer Center, Case Western Reserve University, in Cleveland, Ohio.
This retrospective analysis of patients with advanced or metastatic non–small-cell lung cancer (NSCLC) demonstrated a more than 10% difference in the use of biomarker testing among black patients versus white patients, according to Dr. Bruno.
This significant difference in testing between white and black patients to determine the best systemic or targeted therapy may explain, in part, why twice as many white patients participate in clinical trials compared with black patients.
Access to Care
“While multiple factors are known to impact healthcare disparities, access to and receipt of appropriate biomarker testing may be an attainable goal to ensure equal access to quality care,” said Dr. Bruno. “Biomarker testing for patients with advanced or metastatic NSCLC is a fundamental step to determine the most effective therapies for different genomic and immunologic subtypes of tumors,” she emphasized.
Currently, the national lung cancer treatment guidelines recommend tumor testing for PD-L1 expression and comprehensive genomic testing in patients with metastatic (stage IV) NSCLC.
Biomarker testing “allows for appropriate use of FDA-approved select therapies and identifies genomic alterations that constitute key eligibility criteria for many clinical trials,” Dr. Bruno emphasized.
Since 2020, the FDA has approved 4 targeted therapies for the first-line treatment of patients with metastatic NSCLC and specific genetic or genomic mutations or other alterations.
Although the survival rates for patients with lung cancer have improved lately, Dr. Bruno said, certain racial minorities, especially black people, remain at a disadvantage compared with non-Hispanic white patients.
“The reasons for such disparities are multifactorial but likely to reflect differences in access to high-quality care, including access to clinical trials,” Dr. Bruno said.
Biomarker Testing in Black and White Patients
Dr. Bruno and colleagues used the Flatiron Health database to analyze long-term data of patients with advanced or metastatic NSCLC. Patients were included in the study if they had evidence of receiving targeted therapy in the database between January 2017 and October 2020.
The study cohort was close to 50,000 patients. Of that cohort, the majority of the patients had a non-squamous histology.
Based on the information in this database, only 77% of all the patients with advanced or metastatic NSCLC were ever tested for any biomarker, despite current guidelines calling for PD-L1 testing in all patients with advanced or metastatic NSCLC, Dr. Bruno said.
Black patients, however, were significantly less likely to be tested for any biomarker, including PD-L1 expression, compared with white patients.
Comprehensive genomic testing using next-generation sequencing was performed in only 48.7% of the patients. Of these, less than 40% of black patients ever underwent next-generation sequencing testing, compared with 50% of white patients.
Black patients also had significantly less comprehensive genomic testing before initiation of first-line therapy.
“In a group of patients with non-squamous histology, where biomarker test and uptake may be superior due to the expected higher rates of actionable genomic alterations, black patients had significantly lower utilization of NGS prior to first-line therapy and at any given point in care, when compared with white counterparts,” said Dr. Bruno.
Clinical Trial Participation
Participation in a clinical trial provides patients the only chance to receive new treatments that are not yet approved by the FDA. Such treatments often offer the only therapy for tumors associated with novel biomarkers, for which no treatment is yet available.
Additional factors associated with clinical trial participation for lung cancer include younger age, squamous histology, metastatic disease, and the total number of patients in the specific cancer center.
In the data used for this analysis, only 3.3% of all the patients with non-squamous NSCLC participated in a clinical trial, said Dr. Bruno. The data also show that twice as many white patients participated in a clinical trial than black patients.
Patients who had next-generation sequencing testing were significantly more likely to participate in a clinical trial among all the patients evaluated in this study.
Biomarker Testing Increases Survival
According to Dr. Bruno, the 5-year overall survival rate for patients with stage IV (metastatic) NSCLC is approximately 6%. However, some patients with stage IV NSCLC who are receiving targeted therapies or immunotherapy can survive longer, despite their advanced disease, with up to 50% or 60% of the patients surviving for 5 years or longer, depending on the patient’s biomarker associated with the cancer.
Undergoing biomarker testing before the start of first-line therapy and having next-generation sequencing testing at any point more than doubled the likelihood of the patient also participating in a clinical trial.
Based on this study, black patients are 55% less likely to participate and receive treatment in a clinical trial, Dr. Bruno noted.