Assessment of sociodemographic disparities in outcomes among pts with metastatic NSCLC (mNSCLC) receiving select immuno-oncology (IO) regimens: CORRELATE.
Authors: Liu Stephen V. , Salomonsen Rachel , Tattersfield Ryan , Wang Alice , Cai Ling , Sadow Sam , Peters Solange 
Published: June 2023

9055

Background: IO treatment (tx) has transformed the care of pts with mNSCLC, persistently demonstrating significant survival benefits over chemotherapy. Prior analyses have shown OS and PFS are shorter in the real-world (rw) setting compared with randomized clinical trials (RCTs). A contributing factor may be the more diverse sociodemographic characteristics of pts in the rw. Race and socio-economic status (SES), in particular, have been associated with disparities in cancer outcomes, which may be related to inequalities in healthcare access. One aim of CORRELATE was to assess whether outcomes differ based on sociodemographic characteristics in pts receiving IO in the rw setting. Methods: Eligible pts from the US Flatiron Enhanced Datamart database had mNSCLC (progressed or de novo), started 1L IO tx between Nov 1 2016 and May 31 2021, and met eligibility criteria based on 6 RCTs (KEYNOTE [KN]-024, KN-189, KN-407, IMpower150, CheckMate [CM] 9LA and CM 227) for IO regimens approved in the US for mNSCLC. Flatiron’s area-level measure of SES, available for pts treated at community oncology centers, was based on a validated composite index and has 5 levels (highest [5] to lowest [1]). Multivariate Cox regression models were used to determine the association of sociodemographic variables (age, sex, race, US region and SES) with OS and rwPFS separately; smoking history, ECOG performance status (PS) and PD-L1 expression were also included in the models, as were any pairwise interactions that were statistically significant ( P< 0.05). Results: 2070 pts with non-missing data on the variables of interest were included in the dataset: 60% were aged ≥65 y, 86% white, 55% male and 53% were from the US Southern region. SES was relatively evenly distributed (SES 1–5: 18%, 22%, 21%, 24% and 15%, respectively); 41% of pts had PD-L1 ≥50% (17% unknown PD-L1 expression), 61% had ECOG PS 1 and 92% were former/current smokers. Median OS was 13.3 mos (95% CI 12.3–14.7); median rwPFS was 5.9 mos (5.6–6.2). In the multivariate analyses, race, region and SES did not have a statistically significant association with either OS or rwPFS. Older age (≥65 y; P= 0.0091) and male sex ( P< 0.0001) were associated with a higher risk of death (HR [95% CI] 1.16 [1.04–1.29] and 1.28 [1.15–1.43], respectively). For rwPFS, the interaction between sex and smoking status was statistically significant ( P= 0.0312); specifically, female non-smokers had a higher risk of progression or death vs female smokers (HR 1.45 [95% CI 1.15–1.82]). Conclusions: Our results from a nationally representative dataset of pts with mNSCLC treated at non-academic facilities show that, in pts who had equivalent access to IO tx, the OS and rwPFS benefits derived from IO were similar, irrespective of race, region or SES. More efforts are required to identify and address barriers of access to care to ensure that all pts receive appropriate cancer tx.