Lung Cancer Disparities in Hispanics: Molecular Diagnosis and Use of Immunotherapy

Raez, Luis E.; Cardona, Andrés Felipe; Arrieta, Óscar; Lopes, Gilberto

doi:10.1200/go.20.00004

Cited by 21 publications

(19 citation statements)

References 23 publications

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“…The majority of studies came from Europe and Asia; there was only one study from South America included in the submutation analyses and this study was not included in the overall EGFR mutation analysis. This low number of studies from central and South America may be because EGFR mutation testing is low in Latin American countries, potentially as a result of lack of access [ 109 ]. A recent analysis of 4389 patients has shown that molecular testing is requested in only 76% of lung-cancer cases in Latin America, compared with 97%, 79%, and 90% in the USA, Europe, and Japan, respectively [ 110 ].…”

Section: Discussionmentioning

confidence: 99%

Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis

et al. 2021

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Background Identification of variable epidermal growth factor receptor ( EGFR ) gene mutations in non-small cell lung cancer (NSCLC) is important for the selection of appropriate targeted therapies. This meta-analysis was conducted to provide a worldwide overview of EGFR mutation and submutation (specifically exon 19 deletions, exon 21 L858R substitutions, and others) prevalence, and identify important covariates that influence EGFR mutation status in patients with advanced NSCLC to address this clinical data gap. Methods Embase ® and MEDLINE ® in Ovid were searched for studies published between 2004 and 2019 with cohorts of ≥ 50 adults with EGFR mutations, focusing on stage III/IV NSCLC (≤ 20% of patients with stage I/II NSCLC). Linear mixed-effects models were fitted to EGFR mutation endpoints using logistic transformation (logit), assuming a binomial distribution. The model included terms for an intercept reflecting European studies and further additive terms for other continents. EGFR submutations examined were exon 19 deletions, exon 21 L858R substitutions, and others. Results Of 3969 abstracts screened, 57 studies were included in the overall EGFR mutation analysis and 74 were included in the submutation analysis relative to the overall EGFR mutation population (Europe, n = 12; Asia, n = 51; North America, n = 5; Central America, n = 1; South America, n = 1; Oceania, n = 1; Global, n = 3). The final overall EGFR mutations model estimated Asian and European prevalence of 49.1% and 12.8%, respectively, and included an additive covariate for the proportion of male patients in a study. There were no significant covariates in the submutation analyses. Most submutations were actionable: exon 19 deletions (49.2% [Asia]; 48.4% [Europe]); exon 21 L858R substitutions (41.1% [Asia]; 29.9% [Europe]). Conclusions Although EGFR mutation prevalence was higher in Asian than Western countries, data support worldwide testing for EGFR overall and submutations to inform appropriate targeted treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1007/s40291-021-00563-1.

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Section: Discussionmentioning

confidence: 99%

Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis

et al. 2021

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“…With the increasing prevalence of direct treatment strategies targeting specific mutations (eg, EGFR) , the presence of these oncogenic drivers may play a greater role in survival differences, because they may not be evenly distributed by race and ethnicity. Some research suggests that Hispanics have a higher prevalence of oncogenic drivers than NHWs, but these results are inconsistent and complicated by the fact that Hispanics comprise a racially and genetically diverse group, and rates of certain mutations like EGFR vary based on country of origin ( 55 ). These inconsistencies, coupled with the fact that Hispanics face substantial barriers to care (lower rates of treatment, underrepresentation in clinical trials), suggest that differential somatic mutations alone are insufficient to explain racial and ethnic disparities in lung cancer outcomes ( 55 , 56 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some research suggests that Hispanics have a higher prevalence of oncogenic drivers than NHWs, but these results are inconsistent and complicated by the fact that Hispanics comprise a racially and genetically diverse group, and rates of certain mutations like EGFR vary based on country of origin ( 55 ). These inconsistencies, coupled with the fact that Hispanics face substantial barriers to care (lower rates of treatment, underrepresentation in clinical trials), suggest that differential somatic mutations alone are insufficient to explain racial and ethnic disparities in lung cancer outcomes ( 55 , 56 ). Other proposed mechanisms, including ethnic differences in diet (eg, bean consumption) ( 57 ) and cellular aging (eg, epigenetic methylation) ( 58 ), have less empirical and conceptual support and are unlikely to meaningfully drive lung cancer mortality differences.…”

Section: Discussionmentioning

confidence: 99%

Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review

Price

Flores

Hamann

et al. 2021

JNCI Cancer Spectrum

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Background Despite a substantially worse risk factor profile, Hispanics in the United States experience lower incidence of many diseases and longer survival than non-Hispanic Whites (NHWs), an epidemiological phenomenon known as the Hispanic Health Paradox (HHP). This systematic review evaluated the published longitudinal literature to address whether this pattern extends to lung cancer survival. Methods Searches of Medline, PubMed, Embase, Web of Science, and the Cochrane Library were conducted for January 1, 2000 to July 18, 2018. Records were restricted to articles written in English, employing a longitudinal design, and reporting a direct survival comparison (overall survival, OS; cancer-specific survival, CSS) between NHW and Hispanic lung cancer patients. Results A final sample of 29 full-text articles were included, including 28 fully adjusted models of OS and 21 of CSS. Overall, 26 (92.9%) OS models and 20 (95.2%) CSS models documented either no difference (16 OS, 11 CSS) or a Hispanic survival advantage (10 OS, 9 CSS). Both larger studies and those including foreign-born Hispanics were more likely to show a Hispanic survival advantage, while two studies of exclusively non-smokers showed a survival disadvantage. A number of reporting gaps were identified including Hispanic background and sociodemographic characteristics. Conclusions Hispanics exhibit similar or better survival in the context of lung cancer relative to NHWs despite a considerably worse risk factor profile. These findings support the HHP in the context of lung cancer. Further research is needed to understand the potential mechanisms of the HHP as it relates to lung cancer.

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“…For example, in a study of approximately 1400 women with HER2‐positive breast cancer who were treated with HER2‐targeted therapies in one cancer center, the risk of cardiotoxicity was about as twice as high among Black women as among White women (OR, 1.92; 95% CI, 1.23‐2.98) after controlling for treatment, risk factors, and measures of SES 209 . The inclusion of diverse populations in clinical trials is important to address genetic variations that lead to disparate responses to cancer therapeutics 199,208,210,211,212 …”

Section: Future Directions (Next Steps)mentioning

confidence: 99%

American Cancer Society's report on the status of cancer disparities in the United States, 2021

Islami

Guerra

Minihan

et al. 2021

CA A Cancer J Clinicians

162

121

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In this report, the authors provide comprehensive and up‐to‐date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5‐year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.

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Lung Cancer Disparities in Hispanics: Molecular Diagnosis and Use of Immunotherapy

Cited by 21 publications

References 23 publications

Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis

Worldwide Prevalence of Epidermal Growth Factor Receptor Mutations in Non-Small Cell Lung Cancer: A Meta-Analysis

Ethnic Differences in Survival Among Lung Cancer Patients: A Systematic Review

American Cancer Society's report on the status of cancer disparities in the United States, 2021

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