WCLC 2026 | Racial and ethnic disparities in NSCLC molecular profiles and survival

Yeah, so, I mean, certainly non-small cell lung cancer over the last, you know, 10 years, 10, 15 years has really dramatically changed, you know, long-term survival. It’s improved five-year overall survival from 5% to 15%. However, you know, many of those seminal studies, when you look at, you know, race, ethnicity, composition in the studies, they’re predominantly non-Hispanic white population. And, you know, in terms of looking at patients who are Hispanic or non-Hispanic black patients in the studies, you know, they only comprise like 2% to 5% of the study population. And there have been kind of mixed, you know, there have been a lot of single institution retrospective studies, including one that we did at our own institution, which we did see differing survival between the different race ethnicities. We, for example, showed that non-Hispanic whites and Asian Pacific Islanders had a longer overall survival while non-Hispanic blacks and Hispanics had a shorter overall survival but there have been other retrospective single institution studies that have shown kind of where there isn’t a difference so you know we worked you know so the rationale here was to try to do look at a larger data set of which that we are able to then get a better sense as to whether or not there are really race ethnicity differences in terms of survival molecular subtype makeup and an immune microenvironment so in collaboration with Keras Life Sciences we looked at nearly 40,000 non-small cell lung cancer tumors. The cohort consisted of about 80% non-Hispanic white, about 7% Asian Pacific Islander, and I believe about 5% of Hispanic and non-Hispanic black cases, of which we showed that Asian Pacific Islanders were more, had histology more enriched with adenocarcinoma. And when we looked at molecular subtypes of tumors, we showed that the tumors that were from patients with Asian Pacific Islander race had fewer, a lower prevalence of TP53, STK11, and KEAP1 mutations. And we saw the converse of that in non-Hispanic black cases, which there were more cases with STK11, KEAP1, TP53 mutations. When we looked at the overall survival, it did correlate with Asian Pacific Islanders having the longest median overall survival. But interestingly, when we looked at cases that received immune checkpoint inhibitors, actually non-Hispanic blacks numerically had the longest median overall survival among those cases that received immune checkpoint inhibitors compared to other race ethnicities. We did look at the tumor microenvironment of which there were some modest differences. Non-Hispanic blacks had a lower cell fraction of CD8 T cells and macrophages compared to notably Asian Pacific Islanders but you know these results really show that there are molecular subtype differences but they don’t necessarily correlate with you know kind of responses particularly to immunotherapy of which you know we do need to do more kind of investigations to better understand the tumor immune microenvironment and how that might impact differences in race, ethnicity, and non-small cell lung cancer.

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