Disparities and Precision Oncology

By Dipesh Uprety 

Dr. Siddhartha Devarakonda, a director of Thoracic Medical Oncology at the Swedish Cancer Institute, presented on Disparities and Precision Medicine. Profiling the molecular characteristics of a patient’s tumors involves analysis of tumors at various levels, including DNA and RNA sequence data, protein levels, and often, immune repertoires. Tailoring therapy based on the molecular characteristics of the tumor is called precision medicine. However, there are racial disparities in the molecular characteristics of tumors. For instance, EGFR mutant lung cancer is more common   in the East Asian population as compared to the populations in the United States, Europe and Africa.

The American Association of Cancer Research Project Genomics Evidence Neoplasia Information Exchange (GENIE) is a publicly available cancer data registry with clinically annotated genomic sequencing information to facilitate precision medicine research. An analysis of the GENIE project showed that minorities are not adequately represented [1]. White patients were adequately or over-represented for all cancers except lung and melanoma. In contrast, Asian and Pacific Islander patients showed significant over-representation and black patients were under-represented in all cancers except for melanoma and cervical [1]. Additionally, these minorities are often underrepresented in precision oncology clinical trials [2].  

Dr. Devarakonda gave an example of the ADAURA trial, where only 43% of patients in the placebo arm received osimertinib after experiencing disease progression, despite it being the standard of care [3].  He also showed numerous pictures and made us realize that many patients will receive suboptimal care in different parts of the world. While disparities exist and need to be addressed, Dr. Devarakonda emphasized that there is no “one size fits all” solution. Finally, Dr. Devarakonda concluded his presentation by citing an epidemiological study supporting the use of a 20-year smoking duration instead of 20-packyear smoking history in determining eligibility for lung cancer screening [4]. This strategy may help reduce disparities in screening patients for lung cancer.  

References:  

1. Cheung ATM, Palapattu EL, Pompa IR, Aldrighetti CM, Niemierko A, Willers H, Huang F, Vapiwala N, Van Allen E, Kamran SC. Racial and ethnic disparities in a real-world precision oncology data registry. NPJ Precis Oncol. 2023 Jan 19;7(1):7.   

1. Aldrighetti CM, Niemierko A, Van Allen E, Willers H, Kamran SC. Racial and Ethnic Disparities Among Participants in Precision Oncology Clinical Studies. JAMA Netw Open. 2021 Nov 1;4(11):e2133205.   

1. Tsuboi M, Herbst RS, John T, Kato T, Majem M, Grohé C, Wang J, Goldman JW, Lu S, Su WC, de Marinis F, Shepherd FA, Lee KH, Le NT, Dechaphunkul A, Kowalski D, Poole L, Bolanos A, Rukazenkov Y, Wu YL; ADAURA Investigators. Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC. N Engl J Med. 2023 Jul 13;389(2):137-147.    

1. Potter AL, Xu NN, Senthil P, Srinivasan D, Lee H, Gazelle GS, Chelala L, Zheng W, Fintelmann FJ, Sequist LV, Donington J, Palmer JR, Yang CJ. Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility. J Clin Oncol. 2024 Mar 27:JCO2301780.