Treatment adherence and clinical outcomes of osimertinib in minority patients with advanced EGFR mutated NSCLC

Osimertinib has been one of the most commonly prescribed first-line treatments for EGFR-mutated advanced NSCLC for the last several years for patients with EGFR-mutated non-small cell lung cancer (NSCLC), yet clinical outcomes among racial and ethnic minority patients remain poorly characterized due to underrepresentation in pivotal trials. We conducted a retrospective study of 174 patients with advanced EGFR-mutated NSCLC treated at the Montefiore Einstein Comprehensive Cancer Center (MECCC) from 2015 to 2024 to evaluate real-world survival and treatment adherence. The cohort included 32.2% Hispanic, 28.7% non-Hispanic Black (NHB), 26.4% non-Hispanic White (NHW), and 12.6% Asian patients. In multivariable analyses, NHB patients experienced significantly worse overall survival compared with NHW patients, both in the overall cohort (Hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.02-3.27) and in first-line osimertinib users (HR 3.42, 95% CI 1.48-7.88), despite similar adherence rates. Hispanic and Asian patients also showed trends toward inferior outcomes. These findings highlight survival disparities and underscore the need for inclusive trials and targeted strategies.