Health disparities among cancer patients who received molecular testing for biomarker-directed therapy.

Health disparities present a barrier to successful oncology treatment. The potential for precision oncology to reduce health disparities has not previously been analyzed. We performed a retrospective analysis of 12,627 patients from six major cancer centers whose tumors underwent genomic testing at Caris Life Sciences between 2010-2020. Kaplan-Meier and Cox regression were used to describe and analyze overall survival (OS). Molecular and demographic features of the cohort were analyzed by Chi-square and analysis of variance (ANOVA) tests. Black patients composed 25% of the cohort and White patients 63%. Among this molecularly-tested cohort, there were minimal outcome differences based on race, geographic location, or poverty level. When analyzing the interaction of age, race, and sex, racial-based disparities were noted primarily for young non-White women in the study cohort, but were more pronounced for men and women of all ages in the broader patient population within the SEER database. Mutations in five genes-APC, EGFR, STK11, TP53, and KRAS-were found to affect OS among our cohort and their prevalence varied by race in specific tumor types. Real-world outcomes data in mutation-defined cohorts also provided additional context to previously reported therapeutic response trends. Our study shows that patients who undergo molecular testing display reduced racial health disparities compared to the general population, while persistent racial disparities are influenced by age and sex. Genomic-driven racial disparities should be examined at a tumor lineage-specific level. Increased access to molecular testing for all eligible patients may play a role in improving health equity.