Real-World Incidence of Anaplastic Lymphoma Kinase Alterations in Hispanics with Non-Small Cell Lung Cancer at a Large Academic Institution in Los Angeles

Abstract

Abstract: Race and ethnicity affect the distribution of molecular alterations seen in patients with non–small cell lung cancer (NSCLC). Although anaplastic lymphoma kinase (ALK) alterations are known to occur in 4% to 5% of the population, data specific to the Hispanic population remain limited. This study describes the real-world incidence of ALK alterations in Hispanic patients with NSCLC treated at a large academic institution in Los Angeles, California, United States, to further elucidate the underlying factors that shape differences in mutational profiles. A total of 607 patients with NSCLC treated at Los Angeles General Medical Center (n = 172) and the University of Southern California Norris Comprehensive Cancer Center (n = 435) who received comprehensive genomic profiling were evaluated from January 2015 to June 2023. The Fisher exact test and multivariate logistic regression were incorporated for statistical analysis. Hispanic patients exhibited a higher incidence of ALK alterations (12.76%, n = 18/141) than non-Hispanic patients (5.36%, n = 23/466; P = 0.0046). Multivariate logistic regression showed that Hispanic ethnicity (HR, 2.393; 95% confidence interval, 1.115–5.092) and age at diagnosis (HR, 0.9325; 95% confidence interval, 0.9081–0.9558) were significant variables in ALK alteration incidence, and 55.81% (n = 24) of ALK alterations were initially found via comprehensive genomic profiling. This study highlights a significantly higher incidence of ALK alterations among Hispanic patients with NSCLC, emphasizing the impact of race and ethnicity on molecular alterations. Future research is required to evaluate this trend in a larger, more diverse cohort and investigate the roles of environmental factors and tumor microenvironments in influencing ALK alteration prevalence.

Significance: This study identified a higher incidence of ALK alterations in Hispanic patients with NSCLC (12.76%) compared with that in non-Hispanic patients (5.36%) treated at a large academic center in Los Angeles, highlighting the impact of race on molecular alteration profiles and emphasizing the need to increase access to molecular analyses for this population. The variability in mutational alterations may be influenced by biological and environmental factors.

Figure 1

Distribution of ALK alterations by race/ethnicity. Percentage of all ALK alterations (n = 43) by race/ethnicity. Blue, Hispanic; red, Asian; purple, non-Hispanic White; and turquoise, other/unknown. No Non-Hispanic Blacks had ALK alterations.

Figure 2

Race/ethnicity distribution in 607 patients with NSCLC and 43 ALK alterations by percentage. Blue, percentage of specific race/ethnicity in the total population of NSCLC; red, percentage of ALK alterations by race/ethnicity in the total population of NSCLC.