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. 2024 Oct 1;116(10):1697-1704.
doi: 10.1093/jnci/djae118.

Racial and socioeconomic disparities in survival among patients with metastatic non-small cell lung cancer

Dipesh Uprety  1 , Randell Seaton  2 , Tarik Hadid  1 , Hirva Mamdani  1 , Ammar Sukari  1 , Julie J Ruterbusch  2 , Ann G Schwartz  2
Affiliations

Racial and socioeconomic disparities in survival among patients with metastatic non-small cell lung cancer

Dipesh Uprety et al. J Natl Cancer Inst. .

Abstract

Background: Immune checkpoint inhibitors have profoundly impacted survival among patients with metastatic non-small cell lung cancer. However, population-based studies evaluating this impact on survival by race and socioeconomic factors are lacking.

Methods: We used the Surveillance, Epidemiology, and End Results Program-Medicare database to identify patients with metastatic non-small cell lung cancer diagnosed between 2015 and 2019. The primary study outcomes were the receipt of an immune checkpoint inhibitor and overall survival. χ2 tests and logistic regression were used to identify demographic factors associated with receipt of immune checkpoint inhibitors. The Kaplan-Meier method was used to calculate 2-year overall survival rates, and log-rank tests were used to compare survival by race and ethnicity.

Results: Of 17 134 patients, approximately 39% received an immune checkpoint inhibitor. Those diagnosed with cancer recently (in 2019); who are relatively younger (aged younger than 85 years); non-Hispanic White, non-Hispanic Asian, or Hispanic; living in high socioeconomic status or metropolitan areas; not Medicaid eligible; and with adenocarcinoma histology were more likely to receive immune checkpoint inhibitors. The 2-year overall survival rate from diagnosis was 21% for the overall population. The 2-year overall survival rate from immune checkpoint inhibitor initiation was 30%, among those who received at least 1 cycle and 11% among those who did not receive immune checkpoint inhibitors. The 2-year overall survival rates were higher among non-Hispanic White (22%) and non-Hispanic Asian (23%) patients compared with non-Hispanic Black (15%) and Hispanic (17%) patients. There was no statistically significant racial differences in survival for those who received immune checkpoint inhibitors.

Conclusion: Immune checkpoint inhibitor utilization rates and the resulting outcomes were inferior for certain vulnerable groups, mandating the need for strategies to improve access to care.

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Conflict of interest statement

Uprety: This work was supported by the Karmanos Cancer Institute Core and Service Incentive Program. Dr Uprety serves on the advisory boards and has received consulting fees for Daiichi Sankyo, Sanofi, AstraZeneca, and Jazz Pharmaceuticals.

Seaton and Ruterbusch: This work was supported by the Epidemiology Research Core and the National Cancer Institute Center grant (P30CA022453) awarded to the Karmanos Cancer Institute at Wayne State University.

Hadid: None.

Mamdani: Grants or funding from U Can-Cer Vive Foundation and AstraZeneca (funding to the institution for investigator initiated trial); data safety monitoring board or advisory board for AstraZeneca, Zentalis, Genentech, Daiichi Sankyo.

Sukari: None.

Schwartz: Received grants from National Institutes of Health (to Wayne State University).

Figures

Figure 1.
Figure 1.
Two-year overall survival of the entire population.
Figure 2.
Figure 2.
Two-year overall survival of the entire population by racial-ethnic group. CI = confidence interval; Hisp = Hispanic; NHA = non-Hispanic Asian; NHB = non-Hispanic Black; NHW = non-Hispanic White.
Figure 3.
Figure 3.
A) Two-year overall survival beginning from cancer diagnosis by racial-ethnic group among patients who did not receive immune checkpoint inhibitors. B) Two-year overall survival beginning from first immune checkpoint inhibitor claim by racial-ethnic group among patients who received at least 1 immune checkpoint inhibitor cycle. CI = confidence interval; Hisp = Hispanic; ICI = immune checkpoint inhibitor; NHA = non-Hispanic Asian; NHB = non-Hispanic Black; NHW = non-Hispanic White.
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References

    1. Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. - PubMed
    1. Howlader N, Forjaz G, Mooradian MJ, et al.The effect of advances in lung-cancer treatment on population mortality. N Engl J Med. 2020;383(7):640-649. - PMC - PubMed
    1. Borghaei H, Gettinger S, Vokes EE, et al.Five-year outcomes from the randomized, phase III trials checkmate 017 and 057: nivolumab versus docetaxel in previously treated non-small-cell lung cancer. J Clin Oncol. 2021;39(7):723-733. - PMC - PubMed
    1. Brahmer J, Reckamp KL, Baas P, et al.Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med. 2015;373(2):123-135. - PMC - PubMed
    1. Borghaei H, Paz-Ares L, Horn L, et al.Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med. 2015;373(17):1627-1639. - PMC - PubMed

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