Abstract PO-107: Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB)
Authors: Gupta Anjali , Akinyemiju Tomi 
Published: January 2022

Background: Lung cancer is the most common cause of cancer death among men and women in the United States, with 85% of all cases characterized as non-small cell lung cancer (NSCLC). These cancers are often diagnosed at advanced stage due to inapparent clinical symptoms. In 2015, the Food and Drug Administration approved the first use of immunotherapy for NSCLC, and it has since become a standard modality for treatment among advanced-stage NSCLC patients. Although significant racial disparities have been documented in overall NSCLC survival, it is unclear whether these disparities persist upon equal utilization of immunotherapy. The purpose of this study was to evaluate the association between race and all-cause mortality among advanced-stage non-small cell lung (NSCLC) cancer patients who received immunotherapy. Methods: We obtained data from the 2016 National Cancer Database on patients diagnosed with advanced-stage (III-IV) NSCLC from 2015-2016. The NCDB is a joint project of the American Cancer Society and the Commission on Cancer of the American College of Surgeons, and captures 70% of all patients with newly diagnosed cancer in the United States. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) by race/ethnicity. Additionally, we evaluated the interaction of race/ethnicity with Charlson-Deyo comorbidity score and area-level median income using stratified models and formal tests of interaction. Results: A total of 3,068 patients were included. NH-Black patients had a lower risk of death relative to NH-White patients (HR 0.85; 95% CI 0.74, 0.98) after adjusting for sociodemographic, clinical, and treatment factors. Formal tests of interaction evaluating race with Charlson-Deyo comorbidity score and race with area-level median income were nonsignificant. However, in stratified analyses, NH-Black vs. NH-White patients had a lower risk of death in models adjusted for sociodemographic factors among those with at least one comorbidity (HR 0.76; 95% CI 0.59, 0.98), and those living in regions within the two lowest quartiles of median income (HR 0.82; 95% CI 0.69, 0.98). Conclusions: Among advanced-stage NSCLC patients who received immunotherapy, NH-Black patients experienced higher survival compared to NH-White patients. We urge the implementation of policies and interventions that seek to equalize access to care as a means of addressing differences in overall NSCLC survival by race.

Citation Format: Anjali Gupta, Tomi Akinyemiju. Racial differences in survival among advanced-stage non-small cell lung cancer patients who received immunotherapy: An analysis of the U.S. National Cancer Database (NCDB) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-107.