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Gregory J. Riely, MD, PhD


Next-Generation Sequencing in NSCLC: Racial Inequities in the Community Setting

By: Amy MacDonald, MS
Posted: Monday, January 22, 2024

Standard-of-care biomarker testing for advanced non–small cell lung cancer (NSCLC) often involves comprehensive genomic profiling performed via next-generation sequencing. Although access to such targeted therapy may improve outcomes, racial disparities may limit access for non-White patients in the U.S. community setting.

Gregory A. Vidal, MD, PhD, of West Cancer Center and Research Institute, Memphis, and colleagues sought to uncover the underlying causes of such inequities in care to better inform solutions. Their findings, published in JCO Oncology Practice, demonstrated that within-practice, across-practice, and across-physician inequities all contributed to non-White patients with NSCLC receiving suboptimal access to next-generation sequencing testing. Specifically, Black patients were 8% less likely and Latinx populations were 51% less likely to receive next-generation sequencing–based care than White patients in the measured cohort.

This study, a retrospective data analysis of 12,045 patients, pulled information from the American electronic health record–derived database Flatiron Health. Data were gathered from approximately 280 U.S. cancer clinics. The researchers included White (n = 9,981, 83%), Black (n = 1,528, 13%), and Latinx (n = 536, 4%) patients; other non-White populations such as Asian Americans or Native Americans were not included. Patients were included if they were at least 18 years old, diagnosed with advanced NSCLC (stage IIIB, IIIC, IVA, or IVB) between April 2018 and March 2022, treated in the community setting, and had two or more recorded visits.

To quantify the contribution of physicians and practices to racial inequities in next-generation sequencing testing, “total practice inequity” was defined as the mean percentage point difference in the rate of timely next-generation sequencing testing for Black or Latinx patients when compared with that of White patients. Within- vs across-physician inequities contributed to total inequity for Black and Latinx patients (77% compared with 23%, and 67% compared with 33%, respectively), according to the study authors.

Disclosure: For full disclosures of the study authors, visit

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