Abstract B051: Immunotherapy treatment disparities: A TCR analysis of patients with cutaneous melanoma
Authors: Ramirez Fabiola G. , Alvarado Luis , Dwivedi Alok , Chacon Jessica 
Published: December 2023

Abstract Background: As the deadliest form of skin cancer, advanced-stage melanoma is a devastating disease. Encouragingly, after the introduction of systemic immunotherapy, the overall survival of metastatic melanoma has improved drastically. Immunotherapy is showing superior survival outcomes for patients with advanced stage melanoma, but access to novel immunotherapeutic drugs is not universal for all patients. Herein, we examined the association between various sociodemographic and economic factors and the likelihood of using immunotherapy for the treatment of melanoma in the state of Texas.   Patients and Methods: In this retrospective cohort study, data from the Texas Cancer Registry for the years 2011-2018 was analyzed. The study population included 35963 patients, 18 years and older, diagnosed with cutaneous melanoma. As a primary study outcome, multivariable regression analysis was done to evaluate the association between patient characteristics and likelihood of receipt of immunotherapy. As secondary outcomes, the association between sociodemographic factors and likelihood of presentation with metastasis at diagnosis was examined. Finally, subgroup analysis evaluated general trends between Hispanic and non-Hispanic patients with melanoma. Results: A total of 933 patients underwent immunotherapy. Having metastasis at diagnosis was strongly associated with higher odds of receiving immunotherapy (penalized adjusted OR 28.690, 95% CI 23.470-34.350, p&lt; .0001). Compared to having private insurance, patients were less likely to receive immunotherapy if they were uninsured, had Medicare, or had missing/unknown insurance status (penalized adjusted OR’s 0.700, 0.790, 0.130, p = 0.026, 0.027, and p &lt; .0001 respectively). Hispanic ethnicity did not show a statistically significant association with likelihood of receipt of immunotherapy. Results from our multivariate model highlighted several factors associated with a higher likelihood of presenting with metastatic disease which included Hispanic ethnicity, black race, having no insurance, having Medicare, and belonging to the 10-20% and the 20-100% poverty level groups (p &lt;0.05 for all). When compared to NHW’s, Hispanics with melanoma demonstrate a higher level of poverty, increased risk of metastasis at diagnosis, as well as higher likelihood of being uninsured and living in a border region (p &lt; 0.001 for all).  Conclusion: Immunotherapy has revolutionized the treatment of melanoma. As new immunotherapy drugs reach the market, disparities in utilization of immunotherapy are expected to increase. With this retrospective cohort study, we add to the growing body of evidence recognizing insurance status as a barrier to treatment with immunotherapy. Dermatologic health disparities affecting the Hispanic population underscore the importance of targeted interventions to overcome community level barriers to melanoma diagnosis and care. Finally, this study highlights the need to further evaluate different insurance types and their effect on receipt of immunotherapy.

Citation Format: Fabiola G. Ramirez, Luis Alvarado, Alok Dwivedi, Jessica Chacon. Immunotherapy treatment disparities: A TCR analysis of patients with cutaneous melanoma [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B051.