Researchers detected racial disparities in rates of biomarker testing and clinical trial enrollment in patients with non-small cell lung cancer (NSCLC), according to study results presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting by Debora S. Bruno, MD, of Case Western Reserve University in Cleveland, Ohio, and colleagues.

Dr Bruno and colleagues noted that for patients with advanced and metastatic NSCLC, guidelines recommend using next-generation sequencing (NGS)-based testing for biomarkers. Additionally, according to Dr Bruno and colleagues, biomarker-driven therapies are associated with better overall survival outcomes. However, racial disparities in NSCLC management and outcomes appear to exist.

The study was a retrospective analysis of data from patients obtained from the Flatiron Health Electronic Health Record database. Patients had advanced or metastatic NSCLC and had a record indicating receipt of systemic therapy from January 2017 through October 2020. The researchers evaluated differences according to race regarding biomarker testing and enrollment in trials.

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The analysis included 14,768 patients with NSCLC, of whom nearly two-thirds (66.3%) were White, and 8.7% were Black. A slightly higher percentage (76.4%) of White patients than Black patients (73.6%) had ever undergone biomarker testing (P =.03). NGS-based testing had been performed among 50.1% of the White patients vs 39.8% of the Black patients (P <.0001). Evidence of participation in clinical trials also differed by race, occurring among 3.9% of the White patients vs 1.9% of the Black patients (P =.0002).

In adjusted regression analyses, the use of NGS testing was a factor associated with clinical trial participation. Use of biomarker testing prior to first-line therapy, race, age at diagnosis, histology, stage III or IV disease, and practice volume were also linked to clinical trial participation.

“In conclusion, our study has identified that in real-world practice, Black/African-American patients were significantly less likely to undergo biomarker and NGS testing when compared [with] White counterparts, and [were] also less likely to be treated in clinical trials,” Dr Bruno summarized in her presentation. She also pointed out that of the factors that can affect health care disparities, improvements in access to biomarker testing may be achievable.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Bruno DS, Hess LM, Li XI, Su EW, Zhu YE, Patel M. Racial disparities in biomarker testing and clinical trial enrollment in non-small cell lung cancer (NSCLC). J Clin Oncol. 2021;39:(suppl 15; abstr 9005). doi:10.1200/JCO.2021.39.15_suppl.9005