Racial Disparities in Biomarker Testing and Clinical Trial Enrollment in NSCLC

Rates of comprehensive biomarker testing and clinical trial participation were significantly lower for black patients with advanced non–small-cell lung cancer (NSCLC) in the United States compared with white patients.

Racial disparities exist at many levels in the healthcare system, including cancer care screening to timely diagnosis and treatments received, as well as clinical trial enrollment. This study investigated differences in black versus white race among patients with non–small-cell lung cancer (NSCLC) who underwent biomarker testing and enrolled in clinical trials in the United States.1

This retrospective observational study reviewed data from the Flatiron Health database, which includes longitudinal data of patients with advanced and metastatic NSCLC. Patient data were considered if the patient had received systemic therapy between January 1, 2017, and October 30, 2020. Descriptive analyses summarized differences by race in biomarker testing and trial enrollment. Multivariable regression examined the relationship between these factors.1

Data for a total of 14,768 patients were evaluated: 9793 (66.3%) of the patients were white and 1288 (8.7%) were black.1 Most white patients (76%) and black patients (74%) underwent at least a single molecular test or comprehensive genomic analysis (P = .03).1 Next-generation sequencing (NGS) was performed among 50% of white patients and 40% of black patients (P <.0001).1 Clinical trial participation was observed among 4% of white patients and 2% of black patients (P = .0002).1

There was a statistically significant association between race (white vs black) and both biomarker testing (ever vs never) and trial participation (yes vs no) (both P <.001, unadjusted chi-square).1 Differences in NGS testing, baseline biomarker testing, and race remained statistically significant (P <.01) in adjusted regression analyses.1

Receipt of first-line targeted therapy was comparable between white and black patients (10% and 9%, respectively; P = .24).1 First-line use of pembrolizumab plus carboplatin plus pemetrexed was observed among 20% of white patients and 20% of black patients; carboplatin plus paclitaxel was observed among 16% and 17%, and single-agent pembrolizumab was observed among 14% and 15%, respectively.1

Use of NGS-based testing, which is recommended by the National Comprehensive Cancer Network Clinical Guidelines in Oncology for patients with advanced or metastatic NSCLC, is the most notable disparity among black patients, with a >10% difference in receipt of this testing versus white counterparts. This may contribute in part to more than double the rate of participation in clinical trials observed among white patients since many second-line and later-line trials use molecular targets as inclusion criteria. While multiple factors are known to affect healthcare disparities, access to and receipt of appropriate biomarker testing may be an attainable goal to ensure equal access to quality care.1


1. Bruno DS, Hess LM, Li X, et al. Racial disparities in biomarker testing and clinical trial enrollment in non-small cell lung cancer (NSCLC). Presented at: 2021 American Society of Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021. Abstract 9005.