Molecular Diagnosis, Clinical Trial Representation, and Precision Medicine in Minority Patients with Oncogene-Driven Lung Cancer

TL;DR

This paper reviews how minority patients with lung cancer face disparities in molecular diagnostics and precision medicine, despite advances in targeted therapies for oncogene-driven subtypes.

Contribution

The paper highlights disparities in clinical trial representation and molecular testing among minority patients and emphasizes the need for equity in precision oncology.

Findings

Minority patients have lower rates of molecular testing and underrepresentation in clinical trials for oncogene-driven lung cancer.

Disparities in access to precision therapies affect survival outcomes and limit generalizability of trial results.

Differences in oncogenic driver mutation prevalence across populations underscore the need for diverse clinical research.

Abstract

Lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide. Advances in molecular profiling and targeted therapies have significantly transformed the treatment landscape for non-small cell lung cancer, especially among patients with oncogene-driven subtypes, leading to marked improvements in clinical outcomes. Despite these strides, disparities in access to molecular diagnostics and precision therapies persist, disproportionately impacting minority populations. These inequities result in lower rates of molecular testing, reduced access to specialized treatments, and underrepresentation in clinical trials, thereby limiting the generalizability of trial findings to diverse populations. In this review, we examine the current state of molecular diagnostics and precision medicine for minority patients with oncogene-driven lung cancer, emphasizing existing challenges, emerging opportunities, and future strategies to promote equity in precision oncology.

Lung cancer remains the leading cause of cancer-related death in the US and worldwide. Recent advances in molecular profiling and targeted therapies have revolutionized the management of non-small cell lung cancer (NSCLC), particularly in oncogene-driven subtypes. These therapies selectively target key molecular alterations in EGFR, ALK, KRAS, ROS1, MET, RET, ERBB2 (HER2), BRAF V600E, and NTRK, resulting in substantial improvements in survival rates and quality of life for lung cancer patients. However, disparities in molecular diagnostics and precision treatments persist, disproportionately affecting minority patients. These inequities include underrepresentation in clinical trials, disparities in molecular testing, and barriers to treatment access. The limited participation of racial and ethnic minorities in landmark clinical trials raises concerns about the generalizability of findings and their applicability to diverse populations. In this review, we examine the current landscape of molecular diagnosis and precision medicine in minority patients with oncogene-driven lung cancer, highlighting challenges, opportunities, and future directions for achieving equity in precision oncology. Additionally, we discuss differences in the prevalence of oncologic driver mutations across populations and emphasize the urgent need for greater diversity in clinical research. Addressing these gaps is critical to improving survival outcomes and ensuring equitable access to personalized lung cancer care for all patients.

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