Ancestry-based differences in gene alterations in non–small cell lung cancer: Real-world data using genetic ancestry analysis.
Authors: Miura Keita , Shukuya Takehito , Greenstein Ray , Kaplan Benjamin G , Wakelee Heather A. , Kurokawa Kana , Furuta Kazuyuki , Suh Junghee , Sokol Ethan , Carbone David Paul , Takahashi Kazuhisa 
Published: June 2022

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Background: Racial differences in morbidity and mortality of non-small cell lung cancer (NSCLC) have been demonstrated and some genomic alterations (e.g. EGFR) in NSCLC are known to differ according to race. However, studies have been limited in sample size and hence, limited in their capacity to detect discrepancies in less frequently altered genes. Here, we investigated alteration prevalence in a large real-world NSCLC cohort, stratified by genetic ancestry. Methods: 75,362 NSCLC patients from the United States, were profiled with comprehensive genomic profiling (CGP) of tissue biopsy, as part of routine clinical care (Foundation Medicine Inc., FMI; Frampton GM, et al. Nat Biotechnol 2013). 296 genes targeted across all assays were examined for known/likely pathogenic alterations of all classes. Predominant genetic ancestry was inferred using a SNP-based approach (Newberg J, et al. AACR 2019), and patients were categorized into European (EUR), African (AFR), East Asian (EAS), Admixed American (AMR), and South Asian (SAS) ancestry groups. Patients were additionally stratified by histological type, age (≥40/ < 40), and sex. The prevalence of high tumor mutational burden (TMB-High), defined as ≥ 10 mutations/mb (Chalmers ZR, et al. Genome Med 2017), and microsatellite instability status (Trabucco, et al. J Mol Diagn 2019) was also calculated. Results: In this NSCLC cohort, ancestry was split 82.2% for EUR, 10.0% for AFR, 4.4% for EAS, 2.7% for AMR, and 0.8% for SAS. 50.4% were female (n = 37,972) and 49.6% male (n = 37,360). The most prevalent alterations in the overall cohort included TP53 (67.5%), KRAS (30.6%), CDKN2A (29.2%), CDKN2B (17.2%), STK11 (16.1%), and EGFR (15.3%). The prevalence of TMB-High status in the overall cohort was 34.6%. Stratified by ancestry, the prevalence of EGFR alterations was significantly enriched in EAS vs. other ancestry groups ( p < 0.001). KRAS and STK11 were enriched in EUR and AFR vs. other groups ( p < 0.001). TMB-High status was significantly enriched in AFR vs. all other groups ( p < 0.001). In EAS and SAS, TMB-High was typically reduced vs. other ancestry groups (TMB-High AFR 41.6%, AMR 20.1%, EAS 14.1%, EUR 35.5%, SAS 11.7%). A similar analysis based on sex revealed differences in prevalence of 80 gene alterations and TMB-High with sex-specific enrichments (e.g., EGFR 19.0% female vs. 11.5% male; KRAS 34.6% vs. 26.6%). With respect to age, the prevalence of 41 gene alterations and TMB-High were significantly different between samples from patients age < 40 and age ≥ 40 (e.g., ALK 21.1% age < 40 vs. 2.7% age ≥ 40; KRAS 13.0% vs. 30.8%; TMB-High 14.4% vs. 34.8%). Conclusions: Comprehensive analysis of this real-world dataset, which includes the largest NSCLC patient cohort, revealed ancestry-associated differences in genomic alterations in NSCLC. Age and sex were also associated with differences in genomic alteration and TMB-High prevalence.