Abstract A158: Racial and ethnic variation in conversion from actionable Guardant360 results to matched targeted therapy in non–small cell lung cancer: A real-world analysis

Abstract

Although racial and ethnic disparities in genomic testing access are well documented in non–small cell lung cancer (NSCLC), it remains unknown whether disparities persist downstream in the conversion from an actionable result to matched targeted therapy. This step involves only patients who have already been tested and have an actionable finding, and could reflect differences in access to costly therapies or payer coverage. We hypothesized that patients from racial and ethnic minority groups would have lower odds of receiving matched therapy and tested this among patients with confirmed actionable alterations. We conducted a retrospective cohort study using InfinityAI (Guardant Health, Palo Alto, CA), a longitudinal, multimodal database that links de-identified claims to Guardant360 test results. Adults with NSCLC who underwent Guardant360 testing between 2018 and 2025, harbored an FDA-approved actionable alteration on or after the therapy approval date, and had at least one systemic therapy claim within 180 days of the report date were included; patients with KRAS G12C or ERBB2 alterations detected prior to first-line therapy were excluded, as these targets are approved only for second-line or later (2L+) use. The primary outcome was receipt of matched targeted therapy within 6 months. Multivariable logistic regression was used to adjust for age, sex, smoking status, payer, clinical setting, line of therapy, alteration type, and test year; race was unknown for 16% of patients, and these patients were excluded from the adjusted model. Of 17,200 eligible patients, 11,786 (68.5%) received matched therapy. Median age was 68 years, and 63% of patients were female. Conversion rates varied by alteration: ALK 84.0%, EGFR sensitizing 76.0%, RET 73.7%, MET 64.6%, EGFR exon 20 53.5%, ROS1 49.6%, ERBB2 45.1%, BRAF 40.1%, KRAS G12C 34.7%. Among racial and ethnic groups, non-Hispanic White patients had the lowest unadjusted rate (64.8%). In the adjusted model (n=14,377), Black (aOR 1.21; 95% CI 1.07–1.37; p=0.002) and Asian/Pacific Islander patients (aOR 1.22; 1.09–1.36; p<0.001) had higher odds of matched therapy than non-Hispanic White patients; White Hispanic/Latino patients did not differ from non-Hispanic White patients (aOR 1.13; p=0.19). Treatment in an academic setting was associated with higher conversion vs community practices (aOR 1.16; 1.07–1.25; p<0.001); smoking history was associated with lower conversion (aOR 0.80; 0.73–0.87; p<0.001). Later lines of therapy were associated with lower odds of conversion than first-line (2L aOR 0.47; 3L 0.48; 4L+ 0.47; all p<0.001). Odds also fell with each successive testing year (aOR 0.49 for ≥2024 vs ≤2018; p<0.001). Among patients with an actionable ctDNA result, racial and ethnic minority status was not associated with lower adjusted odds of receiving matched therapy. Conversion was strongly associated with smoking, academic versus community setting, and line of therapy. These gaps represent modifiable targets for improving equity in precision oncology. Anya D. Khan, Jiemin Liao, Amar Das, Jason Porter. Racial and ethnic variation in conversion from actionable Guardant360 results to matched targeted therapy in non–small cell lung cancer: A real-world analysis [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A158.