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Updated: Jun 23, 2026

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Published on: November 22, 2021

Who Gets Left Out of Precision Oncology? Real-World Driver Mutation Expression Patterns and Therapeutic Eligibility

Grace Ha1, Lesly Diaz Chacha2, Lesley Coe2

  • 1Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, United States. gha@montefiore.org.

Journal of Racial and Ethnic Health Disparities
|June 20, 2026
PubMed
Abstract

Insights

Atypical EGFR and non-G12C KRAS mutations are common in lung adenocarcinoma, particularly in Black and Hispanic patients. This suggests potential disparities in precision oncology access for these underrepresented groups.

Area of Science:

  • Oncology
  • Genomics
  • Health Disparities

Background:

  • Precision oncology for non-small cell lung cancer (NSCLC) relies on identifying actionable genomic alterations.
  • Clinical trials often underrepresent racial/ethnic minorities and lack comprehensive subtype characterization of mutations.
  • Real-world data is needed to understand biomarker patterns in diverse lung adenocarcinoma populations.

Purpose of the Study:

  • To define real-world patterns of genomic alterations, including subtype distributions, in a diverse lung adenocarcinoma cohort.
  • To investigate the association between race/ethnicity and specific mutation subtypes.
  • To identify potential disparities in precision oncology based on biomarker patterns.

Main Methods:

  • Retrospective analysis of lung adenocarcinoma patients who underwent surgical resection (2021-2025) with available next-generation sequencing (NGS).
  • Categorization of EGFR mutations into typical versus atypical (PACC variants, exon 20 insertions, T790M, non-L858R exon 21 alterations).
  • Categorization of KRAS mutations into G12C versus non-G12C variants.

Main Results:

  • The cohort (n=292) was diverse: 40.8% non-Hispanic Black, 28.1% Hispanic, 16.1% non-Hispanic White, 6.2% Asian.
  • Hispanic ethnicity was independently associated with EGFR positivity (aOR 3.88).
  • Atypical EGFR mutations occurred in 26% of EGFR-positive tumors, with higher proportions in Black (37%) and Hispanic (27%) patients.
  • 58% of KRAS mutations were non-G12C variants, not associated with any specific racial/ethnic subgroup.

Conclusions:

  • Atypical EGFR and non-G12C KRAS mutations are prevalent in lung adenocarcinoma, with EGFR subtypes appearing more common in Black and Hispanic patients.
  • These findings suggest a potential structural gap in precision oncology, disproportionately affecting underrepresented populations.
  • Comprehensive NGS and inclusive clinical trial design are crucial for ensuring equitable access to biomarker-driven therapies.
Keywords:
BiomarkersLung adenocarcinomaMutationsNext-generation sequencingPrecision oncology

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