Female Authorship in KRAS-Targeted Clinical Trials for Non-Small Cell Lung Cancer: A Bibliometric Analysis of Trends

Female Authorship in KRAS-Targeted Clinical Trials for Non-Small Cell Lung Cancer: A Bibliometric Analysis of Trends | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Female Authorship in KRAS-Targeted Clinical Trials for Non-Small Cell Lung Cancer: A Bibliometric Analysis of Trends Suchir Ryali, Rohith Ryali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7207994/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Despite efforts to improve gender equity in oncology research, female representation in authorship remains disproportionately low. This study analyzed authorship trends in 153 clinical trials investigating therapies that target the KRAS gene in lung cancer published between 2010 and mid-2025. Using bibliometric methods and gender classification tools, we evaluated the proportion of female authors in first, last (senior), and overall authorship roles, and further stratified findings by clinical trial phase. Among 306 first and last authors, only 82 (26.80%) were women. Female first authorship ranged from 16.67 percent to 66.67 percent, while female senior authorship peaked at 50 percent in 2016 and 2021 but was zero in multiple years including 2010, 2012, 2013, and 2020. Across all years, female authorship remained below 50 percent annually, with no statistically significant increase in first or overall authorship (p < 0.001). Senior female authorship did show a general increase but remained significantly lower than male senior authorship (p < 0.001). When stratified by trial phase, female first authorship was highest in phase two studies (38.71 percent), and senior authorship was highest in phase one studies (28.57 percent), yet no phase approached gender parity. These findings reveal persistent and substantial gender disparities in authorship within a critical area of lung cancer research, reinforcing the need for targeted interventions to promote equity in academic authorship and leadership across all stages of clinical investigation. Applied Statistics Oncology gender disparities in oncology research bibliometric analysis female authorship phase stratified non-small cell lung cancer KRAS-targeted therapy Figures Figure 1 Figure 2 Figure 3 1. Background KRAS (Kirsten rat sarcoma virus) is a gene that encodes the K-Ras protein, a central player in the RAS/MAPK signaling pathway, which is implicated in several cancers; most notably non-small cell lung cancer (NSCLC), pancreatic ductal adenocarcinoma (PDAC), and colorectal cancer (CRC). In recent years, the KRAS field has seen rapid advancement through the development of targeted therapies, particularly for NSCLC. At the same time, as discussions around gender equity in science gain momentum, persistent concerns remain regarding the underrepresentation of women in KRAS-focused clinical research (Holliday, 2018). Although efforts to address gender disparities in oncology have grown, women continue to be underrepresented across many aspects of clinical investigation (Jagsi, 2012). While precise statistics for female representation in KRAS-targeted clinical trials are limited, broader trends in oncology suggest persistent disparities attributed to factors such as lack of mentorship, systemic bias, limited visibility of female leadership, and work-life balance concerns in competitive academic environments (Silver, 2017). Although subspecialties such as pediatric oncology and breast cancer research may see relatively higher female participation, complex, biomarker-driven trial domains like KRAS-mutant NSCLC may present unique structural barriers. Reducing this gender gap may require not only time but also intentional, data-driven efforts to understand where disparities persist. While still limited, prior analyses have examined how female representation among trainees and researchers manifests in scholarly output–specifically editorial board membership and authorship (Jagsi, 2008). Authorship position can serve as a proxy for research leadership, with first authorship typically reflecting substantive contribution to a project and manuscript, while last authorship is generally associated with seniority, mentorship, and oversight of the study (Zbar, 2011 ). Prior studies in oncology and other fields have identified variable female authorship rates, but few have specifically examined targeted therapies in lung cancer (Yalamanchali, 2021). Moreover, existing literature often focuses on select journals or broader oncology topics, without isolating KRAS-targeted clinical research. Therefore, the objective of this study was to estimate and analyze female authorship trends in KRAS-targeted NSCLC clinical trials from 2010 to 2025 (June) in (1) first authorship, (2) last or senior authorship, and (3) any authorship, using a comprehensive PubMed MEDLINE and ClinicalTrials.gov search strategy. In contrast to other specialties that have seen growth in female authorship, we hypothesize that KRAS-targeted clinical trials may not have demonstrated such a significant upward trend in female representation during the study period. Furthermore, given the diversity in trial design, leadership, and regulatory oversight across clinical trial phases, it is possible that authorship disparities may vary depending on trial phase. Stratifying by phase may reveal whether early-phase or late-phase trials show different patterns in gender representation. This study therefore includes a phase-stratified analysis to evaluate whether these patterns persist across Phase I, II, and III clinical trials. 2. Methods Authorship data were extracted from PubMed MEDLINE and ClinicalTrials.gov using a keyword-based search for original research articles (clinical trials) related to KRAS-targeted therapies in non-small cell lung cancer (NSCLC). Inclusion criteria ensured results were published from January 2010 to June 2025 (partial year). Publications were limited to clinical trials and original research articles and excluded other publication types such as reviews, editorials, and commentaries. No articles were excluded based on author affiliation or level of training. Unlike previous studies that selected a fixed set of journals, this study used a comprehensive PubMed/ClinicalTrials search strategy to capture the full breadth of KRAS-targeted NSCLC clinical research over the past decade. For each included article, complete author lists were recorded. Authors were assigned first or last authorship based on their listed order in each publication. Total numbers of female authors were calculated based on the full author list for each article. Authors’ gender was determined using the ‘gender’ R package. This package infers an author’s gender based on first names using historical name and gender data from the U.S. Social Security Administration (1910–2012). Our analysis included only names that are historically affiliated with women at least 90% of the time. While these algorithms may not assign gender to 100% of authors, we were able to identify more than 90% of names in our dataset. All data analysis was performed using R Studio (Version 2025.05.1 + 513). We assessed annual trends in female representation among first authors, last authors, and any author. In addition to year-by-year trends, we stratified all authorship data by clinical trial phase (Phase I, II, and III) based on information extracted from study titles or descriptions. This allowed us to assess whether gender disparities differed by trial phase. Significance of trends over time was evaluated using Cochran-Armitage trend tests. A P -value less than 0.05 was considered statistically significant. 3. Results Overall Trends in Female Authorship : A total of 153 KRAS-targeted NSCLC clinical studies were included in the analysis, comprising 2,598 authors overall. Among the 306 first and last authors identified, 82 (26.80%) were female. A statistically significant underrepresentation of female authors was observed across first, last, and total authorship categories (p < 0.0001; 95% CI: − 0.5171 to − 0.3818); Fig. 1 . Although female authors were generally present across first, last, and total authorship positions, no significant upward trends were observed in any category over the study period. The proportion of female authorship remained relatively low and stable from 2010 to mid-2025 (June), with no statistically significant increase in first authorship, senior (last) authorship, or total authorship. Unlike findings in other specialties, where first authorship has shown more pronounced growth, the slope of increase in this cohort was minimal across all authorship roles. When analyzing year-over-year trends, no significant differences emerged in female representation across individual years or subgroups; Table 1 , Fig. 2 . However, a distinction was made between female and male authorship in each group–first, senior, all–that was statistically significant. Table 1 Trends in Proportion of Female First Authorship, Senior Authorship, and Any Authorship, Stratified by Year Year Number of Clinical Trial Literature Pieces Published Number of Females in Authorship Position: First Senior (Last) Any 2010 8 4 0 4 2011 15 6 2 8 2012 6 4 0 4 2013 13 5 0 5 2014 12 2 2 4 2015 18 4 6 9 2016 6 2 3 5 2017 10 3 3 6 2018 7 2 1 3 2019 8 4 1 5 2020 9 3 0 3 2021 8 4 4 8 2022 9 2 2 4 2023 6 1 1 2 2024 13 3 6 9 2025 (up to July 8) 5 2 1 3 P-value (compared to male authorship percentages): p < 0.001* p < 0.001* p < 0.001* *Boldface indicates statistical significance. Stratification by Clinical Phase : When stratified by clinical trial phase, disparities remained evident. Female first authorship was highest in Phase II trials (38.71%) and lowest in Phase III trials (21.88%). Female senior (last) authorship was highest in Phase I trials (28.57%) and lowest in Phase II (14.52%). Across all phases, male authors held a clear majority of both first and senior authorship positions, with female representation not exceeding 39% in any category; Fig. 3 . These findings suggest that gender disparities persist across all phases of KRAS-targeted NSCLC clinical research, with slightly higher female representation in early-phase trials. 4. Discussion The overall rate of female authorship in our study was 26.80%, with no statistically significant increase observed over time in first, last, or total authorship roles. While female first authorship showed marginal year-to-year variation, there was no consistent or sustained upward trend. The representation of women as senior (last) authors remained particularly low throughout the study period, but is on an increasing trend. These results contrast with trends reported in other fields, such as orthopaedic surgery, where some subspecialties have seen gradual gains in female authorship–especially in first author positions. Although we can only speculate on contributing factors, prior demographic data and academic research in oncology suggest multiple potential drivers for the persistent gender disparities in authorship. These include the underrepresentation of women in clinical leadership roles, differential access to mentorship and trial funding, slower rates of academic promotion for women, and potential systemic bias in publishing and authorship attribution. Our phase-stratified analysis offers further insight into where disparities may be most pronounced. Female first authorship was somewhat more common in Phase II trials, whereas female senior authorship was most represented in Phase I trials. However, even in these cases, representation never approached parity. These differences may reflect variations in trial sponsorship, leadership, and funding sources across phases. For instance, Phase III trials may favor more established investigators, who are more likely to be male due to historical disparities in promotion and leadership access (Waldhorn, 2023). In contrast, early-phase trials may offer more opportunities for emerging investigators, where female participation may be modestly higher. One likely contributor is the lower proportion of women leading early or late-phase clinical trials in oncology. Leadership of clinical trials–especially in high-profile, biomarker-specific spaces like KRAS-mutated lung cancers–is often associated with senior academic rank, institutional resources, and extensive research networks, which may disproportionately favor male investigators. Further, recent studies have shown that women in oncology are less likely to be principal investigators of industry-funded trials (Teuwen, 2022) and are underrepresented in corresponding author roles, even when they contribute significantly to the research (Filardo, 2016). Differences in academic pathways and subspecialty choice may also affect publication rates. For example, women in oncology may be more likely to specialize in supportive care, palliative medicine, or breast cancer–areas traditionally associated with higher female representation–but less frequently lead trials in molecularly targeted therapies such as KRAS inhibitors. These pipeline dynamics can influence both the quantity and visibility of publications by female researchers in targeted lung cancer trials. Additionally, publication disparities may reflect broader challenges related to academic career retention. Prior research has shown that female physicians are more likely than male colleagues to leave academia or shift to non-research roles due to limited promotion opportunities, lack of institutional support, or disproportionate caregiving responsibilities (Richter, 2020). Even when women remain in academic medicine, they are often underrepresented at the level of full professor, department chair, or editorial board member–roles that are strongly associated with last authorship positions. Publishing bias may also play a role. Women are less likely to be invited for high-profile collaborations, less likely to be listed as senior authors, and may experience differential peer review standards. Editorial board composition can influence author inclusion and reviewer selection, and while female representation among editors in oncology journals is improving, parity remains far off (Dai, 2022). While we did not limit our analysis by journal or impact factor, it remains possible that women are more likely to publish in lower-impact or specialty journals not captured in previous studies. Future research could explore whether publication venue stratification influences apparent gender gaps. Likewise, exploration of intersectional factors–such as race, ethnicity, and international representation–would further illuminate the nuances of academic authorship disparities. Our study has several limitations. Its retrospective, observational design limits causal inference. Although we included all eligible KRAS-targeted NSCLC clinical trials indexed in PubMed from 2010 to mid-2025 (June), we did not stratify by trial phase, funding source, or author academic rank. In addition, gender identification using the ‘gender’ R package–while well validated–relies on binary, historical name data and may not accurately classify all authors, particularly those with unisex or non-Western names. Our threshold of > 90% confidence in gender association was chosen to minimize misclassification, but some degree of error is unavoidable. Finally, we recognize the complexity of studying gender and authorship. Gender equity in academic medicine is shaped by a range of factors beyond those captured in a bibliometric analysis. As such, while this study helps quantify disparities in authorship within KRAS-targeted NSCLC research, it does not fully capture the lived experiences, structural challenges, or career trajectories of women in oncology. 5. Conclusion This study demonstrates that female authors remain underrepresented in KRAS-targeted NSCLC clinical trials, particularly in senior authorship roles. While there has been limited progress over time, gender disparities persist across both first and senior author positions. Notably, stratification by clinical trial phase revealed that these disparities are present across all phases, with slightly higher female first authorship in Phase II trials and higher female senior authorship in Phase I trials. However, no category approached gender parity. These findings suggest that structural inequities in academic authorship are deeply embedded across the clinical research continuum and highlight the need for targeted efforts to improve gender equity in oncology trial leadership at every stage of investigation. Abbreviations KRAS, Kirsten Rat Sarcoma Virus; NSCLC, Non-small cell lung cancer; PDAC, Pancreatic ductal adenocarcinoma; CRC, colorectal cancer Declarations Author Contributions Conceptualization, S.R. and R.R.; methodology, S.R.; software, S.R.; validation, S.R. and R.R.; formal analysis, S.R.; investigation, S.R.; data curation, S.R.; writing–original draft preparation, S.R.; writing–review and editing, R.R; visualization, S.R. All authors have read and agreed to the published version of the manuscript. Conflicts of Interest: The authors declare no conflicts of interest. Funding: The authors did not receive support from any organization for the submitted work. Author Contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Suchir Ryali. The first draft of the manuscript was written by Suchir Ryali and Rohith Ryali reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgments: During the collection of data, the authors used R Studio (Version 2025.05.1 + 513) and the “gender” package (Version 0.6.0) for initial separation of data. However, all data was again manually checked by S.R. Data Availability Statement: No data was generated. Collected data is available given a reasonable request to the corresponding author. References Dai, N., Li, J., Ren, L., & Bu, Z. (2022). Gender representation on editorial boards of leading oncology journals. ESMO open , 7 (5), 100590. https://doi.org/10.1016/j.esmoop.2022.100590 Filardo, G., da Graca, B., Sass, D. M., Pollock, B. D., Smith, E. B., & Martinez, M. A. (2016). Trends and comparison of female first authorship in high impact medical journals: observational study (1994-2014). BMJ (Clinical research ed.) , 352 , i847. https://doi.org/10.1136/bmj.i847 Holliday, E. B., Siker, M., Chapman, C. H., Jagsi, R., Bitterman, D. S., Ahmed, A. A., Winkfield, K., Kelly, M., Tarbell, N. J., & Deville, C., Jr (2018). Achieving gender equity in the radiation oncology physician workforce. Advances in radiation oncology , 3 (4), 478–483. https://doi.org/10.1016/j.adro.2018.09.003 Jagsi, R., Griffith, K. A., Stewart, A., Sambuco, D., DeCastro, R., & Ubel, P. A. (2012). Gender differences in the salaries of physician researchers. JAMA , 307(22), 2410–2417. https://doi.org/10.1001/jama.2012.6183 Jagsi, R., Tarbell, N. J., Henault, L. E., Chang, Y., & Hylek, E. M. (2008). The representation of women on the editorial boards of major medical journals: a 35-year perspective. Archives of internal medicine , 168 (5), 544–548. https://doi.org/10.1001/archinte.168.5.544 Richter, K. P., Clark, L., Wick, J. A., Cruvinel, E., Durham, D., Shaw, P., Shih, G. H., Befort, C. A., & Simari, R. D. (2020). Women Physicians and Promotion in Academic Medicine. The New England journal of medicine , 383 (22), 2148–2157. https://doi.org/10.1056/NEJMsa1916935 Silver, J. K., Slocum, C. S., Bank, A. M., Bhatnagar, S., Blauwet, C. A., Poorman, J. A., Villablanca, A., & Parangi, S. (2017). Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. PM & R : the journal of injury, function, and rehabilitation , 9 (8), 804–815. https://doi.org/10.1016/j.pmrj.2017.06.001 Teuwen, L. A., Young, J., Alessy, S., Özdemir, B. C., Martina, D., Folorunso, S., Bourlon, M. T., Prenen, H., & Segelov, E. (2024). Intersectionality Between Country, Gender and Funding in Authorship for Phase III Trials Presented at the ASCO Annual Meeting 2022. JCO global oncology , 10 , e2400238. https://doi.org/10.1200/GO.24.00238 Waldhorn, I., Bomze, D., Ben-Aharon, I., Schlosser, S., Markel, G., Ludmir, E. B., & Meirson, T. (2023). Gender Gap in Leadership of Clinical Trials. JAMA internal medicine , 183 (12), 1406–1408. https://doi.org/10.1001/jamainternmed.2023.5104 Yalamanchali, A., Zhang, E. S., & Jagsi, R. (2021). Trends in Female Authorship in Major Journals of 3 Oncology Disciplines, 2002-2018. JAMA network open , 4 (4), e212252. https://doi.org/10.1001/jamanetworkopen.2021.2252 Zbar, A., & Frank, E. (2011). Significance of authorship position: an open-ended international assessment. The American journal of the me dical sciences , 341 (2), 106–109. https://doi.org/10.1097/MAJ.0b013e3181f683a1 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7207994","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":490481067,"identity":"1510a05e-0227-455f-93cc-8ad375d8b235","order_by":0,"name":"Suchir Ryali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYHACxgMJQNKAmYHxAZDm4SNGD0wLswFICxtRWkAEUDmbBIhBUIv5jOQHBx78OSxvzs77rPJrjp0MGwPzw0c38GiRuZFmcCCx7bDhzmZ2s9uy25KBDmMzNs7Bo0VCIgGopeFwgsFhNrbbktuYgVp42KTxa0n/cCDhD0RLseS2emK05BgcSGCDaGH8uO0wEVp43hQA/ZJuuOEwG7M047bjPGzMhPzCnr7x4Y8/1vIG548xfvy5rdqen7354WN8WhgEEhBsZh4wiU85CPAfQLAZfxBSPQpGwSgYBSMSAABwJ0W+mnJOjAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0002-7436-4571","institution":"Saint Louis University","correspondingAuthor":true,"prefix":"","firstName":"Suchir","middleName":"","lastName":"Ryali","suffix":""},{"id":490481068,"identity":"66e9e711-2021-4a27-b113-deb6162ef099","order_by":1,"name":"Rohith Ryali","email":"","orcid":"https://orcid.org/0009-0009-7979-9241","institution":"Boston University Chobanian \u0026 Avedisian School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rohith","middleName":"","lastName":"Ryali","suffix":""}],"badges":[],"createdAt":"2025-07-24 18:00:39","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7207994/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7207994/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87572355,"identity":"32616f73-0fa3-45bc-9b80-a43af0384e7e","added_by":"auto","created_at":"2025-07-25 10:57:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":335043,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraph showing the percentage of female authors and male authors (total) in KRAS clinical research literature from 2010 to mid-2025 (June).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Screenshot20250724at12.33.06PM.png","url":"https://assets-eu.researchsquare.com/files/rs-7207994/v1/3ff288f6c68d0c6b1ec269bf.png"},{"id":87572356,"identity":"d2959f84-9c2e-4dca-8cd5-b76f577436e1","added_by":"auto","created_at":"2025-07-25 10:57:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":171220,"visible":true,"origin":"","legend":"\u003cp\u003eTrends in first vs. senior female authorship by year. Graph showing percentage of female \u003cstrong\u003e(A)\u003c/strong\u003e first and\u003cstrong\u003e (B)\u003c/strong\u003e senior/last authors in KRAS clinical-trial literature by year from 2010 to 2025 (June).\u003c/p\u003e","description":"","filename":"Screenshot20250724at12.33.14PM.png","url":"https://assets-eu.researchsquare.com/files/rs-7207994/v1/c5188f25fb5acc6f63979c21.png"},{"id":87572364,"identity":"45326c0d-89ac-4055-b137-e52ca48cc7ba","added_by":"auto","created_at":"2025-07-25 10:57:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":314440,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(A)\u003c/strong\u003e differences among female and male first authorship rates across clinical phases. \u003cstrong\u003e(B)\u003c/strong\u003e differences among female and male senior authorship rates across clinical phases.\u003c/p\u003e","description":"","filename":"Screenshot20250724at12.33.20PM.png","url":"https://assets-eu.researchsquare.com/files/rs-7207994/v1/746ed2f4e5c8cca23f4d883e.png"},{"id":87573607,"identity":"7ab940ce-cb2a-4a58-8f30-a54d3f584e93","added_by":"auto","created_at":"2025-07-25 11:21:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1139885,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7207994/v1/169e6962-d18a-4ae3-b21c-0ca53d6f7238.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFemale Authorship in KRAS-Targeted Clinical Trials for Non-Small Cell Lung Cancer: A Bibliometric Analysis of Trends\u003c/p\u003e","fulltext":[{"header":"1. Background","content":"\u003cp\u003eKRAS (Kirsten rat sarcoma virus) is a gene that encodes the K-Ras protein, a central player in the RAS/MAPK signaling pathway, which is implicated in several cancers; most notably non-small cell lung cancer (NSCLC), pancreatic ductal adenocarcinoma (PDAC), and colorectal cancer (CRC). In recent years, the KRAS field has seen rapid advancement through the development of targeted therapies, particularly for NSCLC. At the same time, as discussions around gender equity in science gain momentum, persistent concerns remain regarding the underrepresentation of women in KRAS-focused clinical research (Holliday, 2018). Although efforts to address gender disparities in oncology have grown, women continue to be underrepresented across many aspects of clinical investigation (Jagsi, 2012). While precise statistics for female representation in KRAS-targeted clinical trials are limited, broader trends in oncology suggest persistent disparities attributed to factors such as lack of mentorship, systemic bias, limited visibility of female leadership, and work-life balance concerns in competitive academic environments (Silver, 2017).\u003c/p\u003e\u003cp\u003eAlthough subspecialties such as pediatric oncology and breast cancer research may see relatively higher female participation, complex, biomarker-driven trial domains like KRAS-mutant NSCLC may present unique structural barriers. Reducing this gender gap may require not only time but also intentional, data-driven efforts to understand where disparities persist. While still limited, prior analyses have examined how female representation among trainees and researchers manifests in scholarly output\u0026ndash;specifically editorial board membership and authorship (Jagsi, 2008).\u003c/p\u003e\u003cp\u003eAuthorship position can serve as a proxy for research leadership, with first authorship typically reflecting substantive contribution to a project and manuscript, while last authorship is generally associated with seniority, mentorship, and oversight of the study (Zbar, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Prior studies in oncology and other fields have identified variable female authorship rates, but few have specifically examined targeted therapies in lung cancer (Yalamanchali, 2021). Moreover, existing literature often focuses on select journals or broader oncology topics, without isolating KRAS-targeted clinical research.\u003c/p\u003e\u003cp\u003eTherefore, the objective of this study was to estimate and analyze female authorship trends in KRAS-targeted NSCLC clinical trials from 2010 to 2025 (June) in (1) first authorship, (2) last or senior authorship, and (3) any authorship, using a comprehensive PubMed MEDLINE and ClinicalTrials.gov search strategy. In contrast to other specialties that have seen growth in female authorship, we hypothesize that KRAS-targeted clinical trials may not have demonstrated such a significant upward trend in female representation during the study period.\u003c/p\u003e\u003cp\u003eFurthermore, given the diversity in trial design, leadership, and regulatory oversight across clinical trial phases, it is possible that authorship disparities may vary depending on trial phase. Stratifying by phase may reveal whether early-phase or late-phase trials show different patterns in gender representation. This study therefore includes a phase-stratified analysis to evaluate whether these patterns persist across Phase I, II, and III clinical trials.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eAuthorship data were extracted from PubMed MEDLINE and ClinicalTrials.gov using a keyword-based search for original research articles (clinical trials) related to KRAS-targeted therapies in non-small cell lung cancer (NSCLC). Inclusion criteria ensured results were published from January 2010 to June 2025 (partial year). Publications were limited to clinical trials and original research articles and excluded other publication types such as reviews, editorials, and commentaries. No articles were excluded based on author affiliation or level of training.\u003c/p\u003e\u003cp\u003eUnlike previous studies that selected a fixed set of journals, this study used a comprehensive PubMed/ClinicalTrials search strategy to capture the full breadth of KRAS-targeted NSCLC clinical research over the past decade. For each included article, complete author lists were recorded. Authors were assigned first or last authorship based on their listed order in each publication. Total numbers of female authors were calculated based on the full author list for each article.\u003c/p\u003e\u003cp\u003eAuthors\u0026rsquo; gender was determined using the \u0026lsquo;gender\u0026rsquo; R package. This package infers an author\u0026rsquo;s gender based on first names using historical name and gender data from the U.S. Social Security Administration (1910\u0026ndash;2012). Our analysis included only names that are historically affiliated with women at least 90% of the time. While these algorithms may not assign gender to 100% of authors, we were able to identify more than 90% of names in our dataset.\u003c/p\u003e\u003cp\u003eAll data analysis was performed using R Studio (Version 2025.05.1\u0026thinsp;+\u0026thinsp;513). We assessed annual trends in female representation among first authors, last authors, and any author. In addition to year-by-year trends, we stratified all authorship data by clinical trial phase (Phase I, II, and III) based on information extracted from study titles or descriptions. This allowed us to assess whether gender disparities differed by trial phase. Significance of trends over time was evaluated using Cochran-Armitage trend tests. A \u003cem\u003eP\u003c/em\u003e-value less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cem\u003eOverall Trends in Female Authorship\u003c/em\u003e:\u003c/p\u003e\u003cp\u003eA total of 153 KRAS-targeted NSCLC clinical studies were included in the analysis, comprising 2,598 authors overall. Among the 306 first and last authors identified, 82 (26.80%) were female. A statistically significant underrepresentation of female authors was observed across first, last, and total authorship categories (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; 95% CI: \u0026minus;\u0026thinsp;0.5171 to \u0026minus;\u0026thinsp;0.3818); Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAlthough female authors were generally present across first, last, and total authorship positions, no significant upward trends were observed in any category over the study period. The proportion of female authorship remained relatively low and stable from 2010 to mid-2025 (June), with no statistically significant increase in first authorship, senior (last) authorship, or total authorship. Unlike findings in other specialties, where first authorship has shown more pronounced growth, the slope of increase in this cohort was minimal across all authorship roles. When analyzing year-over-year trends, no significant differences emerged in female representation across individual years or subgroups; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. However, a distinction was made between female and male authorship in each group\u0026ndash;first, senior, all\u0026ndash;that was statistically significant.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTrends in Proportion of Female First Authorship, Senior Authorship, and Any Authorship, Stratified by Year\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of Clinical Trial Literature Pieces Published\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eNumber of Females in Authorship Position:\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eFirst\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eSenior (Last)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eAny\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025 (up to July 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e (compared to male authorship percentages):\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e*Boldface indicates statistical significance.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eStratification by Clinical Phase\u003c/em\u003e:\u003c/p\u003e\u003cp\u003eWhen stratified by clinical trial phase, disparities remained evident. Female first authorship was highest in Phase II trials (38.71%) and lowest in Phase III trials (21.88%). Female senior (last) authorship was highest in Phase I trials (28.57%) and lowest in Phase II (14.52%). Across all phases, male authors held a clear majority of both first and senior authorship positions, with female representation not exceeding 39% in any category; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. These findings suggest that gender disparities persist across all phases of KRAS-targeted NSCLC clinical research, with slightly higher female representation in early-phase trials.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe overall rate of female authorship in our study was 26.80%, with no statistically significant increase observed over time in first, last, or total authorship roles. While female first authorship showed marginal year-to-year variation, there was no consistent or sustained upward trend. The representation of women as senior (last) authors remained particularly low throughout the study period, but is on an increasing trend. These results contrast with trends reported in other fields, such as orthopaedic surgery, where some subspecialties have seen gradual gains in female authorship\u0026ndash;especially in first author positions.\u003c/p\u003e\u003cp\u003eAlthough we can only speculate on contributing factors, prior demographic data and academic research in oncology suggest multiple potential drivers for the persistent gender disparities in authorship. These include the underrepresentation of women in clinical leadership roles, differential access to mentorship and trial funding, slower rates of academic promotion for women, and potential systemic bias in publishing and authorship attribution.\u003c/p\u003e\u003cp\u003eOur phase-stratified analysis offers further insight into where disparities may be most pronounced. Female first authorship was somewhat more common in Phase II trials, whereas female senior authorship was most represented in Phase I trials. However, even in these cases, representation never approached parity. These differences may reflect variations in trial sponsorship, leadership, and funding sources across phases. For instance, Phase III trials may favor more established investigators, who are more likely to be male due to historical disparities in promotion and leadership access (Waldhorn, 2023). In contrast, early-phase trials may offer more opportunities for emerging investigators, where female participation may be modestly higher.\u003c/p\u003e\u003cp\u003eOne likely contributor is the lower proportion of women leading early or late-phase clinical trials in oncology. Leadership of clinical trials\u0026ndash;especially in high-profile, biomarker-specific spaces like KRAS-mutated lung cancers\u0026ndash;is often associated with senior academic rank, institutional resources, and extensive research networks, which may disproportionately favor male investigators. Further, recent studies have shown that women in oncology are less likely to be principal investigators of industry-funded trials (Teuwen, 2022) and are underrepresented in corresponding author roles, even when they contribute significantly to the research (Filardo, 2016).\u003c/p\u003e\u003cp\u003eDifferences in academic pathways and subspecialty choice may also affect publication rates. For example, women in oncology may be more likely to specialize in supportive care, palliative medicine, or breast cancer\u0026ndash;areas traditionally associated with higher female representation\u0026ndash;but less frequently lead trials in molecularly targeted therapies such as KRAS inhibitors. These pipeline dynamics can influence both the quantity and visibility of publications by female researchers in targeted lung cancer trials.\u003c/p\u003e\u003cp\u003eAdditionally, publication disparities may reflect broader challenges related to academic career retention. Prior research has shown that female physicians are more likely than male colleagues to leave academia or shift to non-research roles due to limited promotion opportunities, lack of institutional support, or disproportionate caregiving responsibilities (Richter, 2020). Even when women remain in academic medicine, they are often underrepresented at the level of full professor, department chair, or editorial board member\u0026ndash;roles that are strongly associated with last authorship positions.\u003c/p\u003e\u003cp\u003ePublishing bias may also play a role. Women are less likely to be invited for high-profile collaborations, less likely to be listed as senior authors, and may experience differential peer review standards. Editorial board composition can influence author inclusion and reviewer selection, and while female representation among editors in oncology journals is improving, parity remains far off (Dai, 2022).\u003c/p\u003e\u003cp\u003eWhile we did not limit our analysis by journal or impact factor, it remains possible that women are more likely to publish in lower-impact or specialty journals not captured in previous studies. Future research could explore whether publication venue stratification influences apparent gender gaps. Likewise, exploration of intersectional factors\u0026ndash;such as race, ethnicity, and international representation\u0026ndash;would further illuminate the nuances of academic authorship disparities.\u003c/p\u003e\u003cp\u003eOur study has several limitations. Its retrospective, observational design limits causal inference. Although we included all eligible KRAS-targeted NSCLC clinical trials indexed in PubMed from 2010 to mid-2025 (June), we did not stratify by trial phase, funding source, or author academic rank. In addition, gender identification using the \u0026lsquo;gender\u0026rsquo; R package\u0026ndash;while well validated\u0026ndash;relies on binary, historical name data and may not accurately classify all authors, particularly those with unisex or non-Western names. Our threshold of \u0026gt;\u0026thinsp;90% confidence in gender association was chosen to minimize misclassification, but some degree of error is unavoidable.\u003c/p\u003e\u003cp\u003eFinally, we recognize the complexity of studying gender and authorship. Gender equity in academic medicine is shaped by a range of factors beyond those captured in a bibliometric analysis. As such, while this study helps quantify disparities in authorship within KRAS-targeted NSCLC research, it does not fully capture the lived experiences, structural challenges, or career trajectories of women in oncology.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study demonstrates that female authors remain underrepresented in KRAS-targeted NSCLC clinical trials, particularly in senior authorship roles. While there has been limited progress over time, gender disparities persist across both first and senior author positions. Notably, stratification by clinical trial phase revealed that these disparities are present across all phases, with slightly higher female first authorship in Phase II trials and higher female senior authorship in Phase I trials. However, no category approached gender parity. These findings suggest that structural inequities in academic authorship are deeply embedded across the clinical research continuum and highlight the need for targeted efforts to improve gender equity in oncology trial leadership at every stage of investigation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eKRAS, Kirsten Rat Sarcoma Virus; NSCLC, Non-small cell lung cancer; PDAC, Pancreatic ductal adenocarcinoma; CRC, colorectal cancer\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, S.R. and R.R.; methodology, S.R.; software, S.R.; validation, S.R. and R.R.; formal analysis, S.R.; investigation, S.R.; data curation, S.R.; writing\u0026ndash;original draft preparation, S.R.; writing\u0026ndash;review and editing, R.R; visualization, S.R. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Suchir Ryali. The first draft of the manuscript was written by Suchir Ryali and Rohith Ryali reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the collection of data, the authors used R Studio (Version 2025.05.1\u0026thinsp;+\u0026thinsp;513) and the \u0026ldquo;gender\u0026rdquo; package (Version 0.6.0) for initial separation of data. However, all data was again manually checked by S.R.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo data was generated. Collected data is available given a reasonable request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDai, N., Li, J., Ren, L., \u0026amp; Bu, Z. (2022). 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Significance of authorship position: an open-ended international assessment. \u003cem\u003eThe American journal of the me\u003c/em\u003e\u003cem\u003edical sciences\u003c/em\u003e, \u003cem\u003e341\u003c/em\u003e(2), 106\u0026ndash;109. https://doi.org/10.1097/MAJ.0b013e3181f683a1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gender disparities in oncology research, bibliometric analysis, female authorship, phase stratified, non-small cell lung cancer, KRAS-targeted therapy","lastPublishedDoi":"10.21203/rs.3.rs-7207994/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7207994/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite efforts to improve gender equity in oncology research, female representation in authorship remains disproportionately low. This study analyzed authorship trends in 153 clinical trials investigating therapies that target the KRAS gene in lung cancer published between 2010 and mid-2025. Using bibliometric methods and gender classification tools, we evaluated the proportion of female authors in first, last (senior), and overall authorship roles, and further stratified findings by clinical trial phase. Among 306 first and last authors, only 82 (26.80%) were women. Female first authorship ranged from 16.67 percent to 66.67 percent, while female senior authorship peaked at 50 percent in 2016 and 2021 but was zero in multiple years including 2010, 2012, 2013, and 2020. Across all years, female authorship remained below 50 percent annually, with no statistically significant increase in first or overall authorship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Senior female authorship did show a general increase but remained significantly lower than male senior authorship (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When stratified by trial phase, female first authorship was highest in phase two studies (38.71 percent), and senior authorship was highest in phase one studies (28.57 percent), yet no phase approached gender parity. These findings reveal persistent and substantial gender disparities in authorship within a critical area of lung cancer research, reinforcing the need for targeted interventions to promote equity in academic authorship and leadership across all stages of clinical investigation.\u003c/p\u003e","manuscriptTitle":"Female Authorship in KRAS-Targeted Clinical Trials for Non-Small Cell Lung Cancer: A Bibliometric Analysis of Trends","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 10:57:29","doi":"10.21203/rs.3.rs-7207994/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"47366421-8589-43c1-9de1-55f4bced4aee","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52080914,"name":"Applied Statistics"},{"id":52080915,"name":"Oncology"}],"tags":[],"updatedAt":"2025-07-25T10:57:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 10:57:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7207994","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7207994","identity":"rs-7207994","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}