Prevalence of Targetable Mutations in Black Patients With Lung Cancer: A Systematic Review and Meta-Analysis.

Abstract

Inferior outcomes of Black patients with lung cancer compared with other racial groups are often linked to socioeconomic factors. It is crucial to determine whether a varying prevalence of targetable mutations limits treatments and contributes to disparities. We conducted a meta-analysis on the prevalence of lung cancer <i>EGFR</i>, <i>ALK</i>, <i>ROS-1</i>, and <i>BRAF</i> mutations in Black patients compared with White, Hispanic, and Asian patients. We searched PubMed/MEDLINE, Cochrane Library, EMBASE, CENTRAL, Google Scholar, and clinicaltrials.gov databases. We selected studies reporting the prevalence of at least one mutation in the Black population. We calculated the pooled prevalence of mutations using fixed effects, exact binomial distributions, and Freeman-Turkey double arcsine transformation to stabilize the variances. Twenty studies with 11,867 patients were included. In Black patients, <i>EGFR</i> was the most prevalent mutation (6%; 95% CI, 5 to 7), followed by <i>BRAF</i> (1%; 95% CI, 0 to 2), <i>ALK</i> (1%; 95% CI, 0 to 2), and <i>ROS-1</i> (0%; 95% CI, 0 to 1). Black patients had a lower prevalence of <i>EGFR</i> mutations than White, Hispanic, and Asian patients (<i>P</i> < .01). <i>BRAF</i> mutations were less prevalent in Black compared with White patients (<i>P</i> < .05), and <i>ALK</i> mutations were less prevalent when compared with Hispanic patients (<i>P</i> < .05). <i>EGFR</i> is the most frequent mutation found in Black patients, although its prevalence is lower than that in other races. Black patients have a low overall prevalence of <i>ALK</i>, <i>ROS-1</i>, and <i>BRAF</i> mutations. Given that disproportional eligibility for targeted therapies may be contributing to inferior outcomes, research focused on the Black population is needed to evaluate specific tumor characteristics and therapeutic strategies.