Primary Care to Oncology – Conversations for Change: Dr Porter Presents Collaborative Case Studies in Lung Cancer
Speaker:
Jason Porter, MD West Cancer Center
Conference:
2025 Health Equity: Primary Care to Oncology—Conversations for Change
At the 2025 Health Equity Primary Care to Oncology—Conversations for Change conference presented by Total Health, Dr Jason Porter from West Cancer Center presented two collaborative case studies in cancer genomics, with a lung cancer focus. With a personal and passionate tone, Dr Porter welcomed the Memphis-based audience by grounding his talk in the lived realities of lung cancer disparities. “This is where the rubber meets the road,” Dr Porter said, describing how the science of “oncogenomics” must be practically and equitably applied in a real-world care setting. He noted that, as a thoracic oncologist, he is acutely aware of the consequences when genomic tools are underutilized—especially in underserved or historically marginalized groups, and in those who might not fit the traditional lung cancer risk profile. “We should be testing everybody... Not just some patients. Not just the ones who ‘look the part.’ Because mutations don’t discriminate—so why should we?”
Disparities and the Imperative to Test
Dr Porter presented some sobering data on racial disparities in lung cancer outcomes, noting that Black individuals are15% less likely to receive an early diagnosis, 19% less likely to undergo surgery, and 12% more likely to receive no treatment at all. In addition, he noted that Black patients are 16% less likely to survive five years compared to white individuals. These gaps, Dr Porter argued, are fueled not only by access barriers, but by diagnostic delays—especially in younger non-smokers who are often dismissed due to their low perceived risk of lung cancer. “A 22-year-old with persistent weight loss and cough shouldn’t be told it’s just reflux,” he stressed, referencing a recent tumor board case at his institution.
Case Study #1: A 74-Year-Old Woman, A Missed Opportunity Avoided
The first case Dr Porter presented described a 74-year-old African American woman who had presented to the emergency department with chest pain, shortness of breath, and fatigue. Her imaging studies revealed a 7-cm mass with bronchial invasion, nodules, and vertebral lesions. Notably, Dr Porter emphasized that while some might have referred her to hospice with such a diagnosis, there was a critical need in this case to “test before treating or giving up…”. In this case, he noted that the patient underwent blood-based genomic profiling, which revealed a MET exon 14 skipping mutation, a targetable oncogene driver mutation, and the patient was started on capmatinib, a MET-specific inhibitor drug. Dr Porter noted “She told me, ‘I don’t want chemo, radiation, or surgery.’ And I said, ‘That’s 99% of what I do!’ But then the mutation came back, and she wept when she saw her scans.” He noted that the patient responded dramatically to therapy, avoided chemotherapy entirely, and was able to return to work full-time—a story that underscores how molecular testing can radically transform a patient’s prognosis and quality of life.
Case Study #2: A 26-Year-Old Man and the Cost of Delay
The second case Dr Porter described was a 26-year-old African American male who presented with dyspnea, weight loss, and a large necrotic right lung mass. His blood-based next generation sequencing (NGS) results returned negative for actionable mutations, and due to his overall disease burden and time constraints, the patient was started on carboplatin, paclitaxel, and pembrolizumab. His response, however, response was minimal. Some weeks later, tumor tissue testing revealed the presence of an ALK gene rearrangement—a fusion that would have made him a candidate for lorlatinib, an ALK-specific inhibitor, from the outset. Dr Porter noted that, in this case, the immunotherapy he had already received posed a new problem: “TKIs [tyrosine kinase inhibitors] after an IO [immune-oncology agent] can trigger severe toxicities like hepatitis or pneumonitis,” Dr Porter warned. For this case, Dr Porter emphasized a central message: “Negative blood NGS is not enough. Especially in young, never-smoking patients, you have to bird-dog the tissue.” He further emphasized that blood NGS testing often misses gene fusion events such as this case, which are large and can be fragmented during processing of circulating tumor DNA (ctDNA). As such, he suggested that tissue NGS, or, at minimum immunohistochemistry (IHC) testing, is essential for a full picture.
Core Clinical Takeaways
Reflecting on these two real world clinical cases, Dr Porter gave some practical advice that he hoped would resonate strongly with both primary care and oncology providers in the audience: 1) Never assume a patient “isn’t a candidate” for testing based on age, smoking history, race, or histology, noting that even squamous histologies may harbor mutations like EGFR. 2) Always test tissue and blood samples when possible, noting that some mutations, especially gene fusions (e.g., ALK, ROS1, RET), require tissue analysis to be detected. 3) Withhold immunotherapy in lung cancer until the patient’s oncogene status is clarified, as IO can in fact be contraindicated and/or harmful for patients with certain mutations, and 4) Cost should not be a barrier for testing. “In my experience,” Dr Porter said, “I haven’t seen a patient turned away from testing because of cost.”
Equity, Advocacy, and Changing the Culture
Dr Porter urged the audience to go beyond clinical best practices, toward advocacy, noting that patients—especially those from underserved communities—often don’t know to ask about NGS testing. “There should be billboards saying: ‘Cancer diagnosis? Ask about NGS.’” Until then, he suggested, it falls to providers across specialties to ensure testing opportunities are not missed. He called for an equity-based approach, especially in younger and BIPOC populations, who are more likely to be dismissed or delayed in diagnosis. “Being a young never-smoker is itself a risk factor for delayed diagnosis and death,” he said pointedly. “Equity means doing more for those at higher risk. Equality isn’t enough.” Dr Porter concluded with a vision for what genomic testing can achieve when used equitably and urged attendees to view every lung cancer case as an opportunity—not just for treatment, but for transformation.
“We don’t want a 22-year-old with an ALK rearrangement to be told it’s reflux. We want that person to live. That’s the power of precision medicine when done right.”
Speaker Disclosure Information: Dr Porter reported no relevant disclosures for this presentation.