Inequities in Biomarker Testing for Lung Cancer in a Low Resource Setting

Introduction: Despite the novel advances in molecular biology which has revolutionized treatment of Non-Small Cell Lung cancers, biomarker testing remains limited in low resource settings including Ghana making the adoption of personalized treatment pathways difficult. Methodology: This was a retrospective review of histology-confirmed lung cancer cases from January 2019 to December 2023. Data extracted from patients’ medical records were analyzed using descriptive statistics. Aim: To describe the proportion and pattern of biomarker testing requested by clinicians involved in diagnosing and managing lung cancer patients Results: A total of 158 medical records cases were retrieved of which male and female proportions were 89(56.3%) and 69(43.7%) respectively. Non-small cell lung cancer constituted 127 (80.4%) all cases. Out of the total number of non-small cell lung cancer cases, 117(92.1%) had adenocarcinoma, 9(7.1%) had squamous cell carcinoma and 1(0.8%) had Adenosquamous carcinoma. Only 22 (17%) of the non-small cell lung cancer cases had biomarker analysis. A total of 49 biomarker reports were retrieved from the 22 patients and the variety as well as the proportions of the assays were as follows; Programmed Death-Ligand-1(PDL1) were 13/49(26.5%), Epidermal Growth Factor Receptor (EGFR) were 12/49(24.5%), Anaplastic Lymphoma Kinase (ALK) were 12/49(24.5%), Kirsten rat sarcoma viral oncogene homolog (KRAS) and ROS proto-oncogene 1 (ROS1) were 6 each representing 1.2% of all cases. The results show that 11/22(50%) of these patients had two different biomarker reports whiles only 1 patient had all 5 biomarker test reports. Discussion: The findings of this study reflect a low level of biomarker profiling of Non-Small Cell Lung cancer cases among our cohort of patients. This certainly has significant implications on lung cancer management and prognosis in our environment. Conclusion: There is an urgent need to address the gaps in biomarker profiling of non-small cell lung cancers diagnosed in our setting. This may be achieved through continuous medical education of treating clinicians, improved molecular testing capacity and advocating for governmental support policies.