Abstract B127: Impact of race on the outcomes of advanced stage non-small cell lung cancer in an equal access setting
Authors: Pasli Melisa , Kannaiyan Radhamani , Namireddy Praveen , Muzaffar Mahvish 
Published: January 2023

Abstract
Introduction: Immunotherapy has improved outcomes in patients with advanced stage lung cancer. However, the studies which led to approval of these therapies did not include a substantial number of Black patients. Studies focusing on racial disparities in advanced stage non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) report conflicting data. In an equal access setting, some studies have demonstrated improved outcomes in Black patients. Very few studies have high or equal representation of Black patients, and these studies lack detail on access to care, such as time to treatment initiation (TTI) in this target population. To our knowledge, this study is one of few with almost equal representation of Black and White patients. Methods: This was an IRB approved retrospective study of stage IV NSCLC patients &gt; 18 years who received immunotherapy-based systemic therapy at Vidant Medical Center between 2014 and 2021. Analyses were done utilizing IBM PSAW (SPSS Version 28). Associations between race and other demographic characteristics were examined using chi-square tests. Kaplan-Meier curves were generated to determine overall survival (OS) and progression-free survival (PFS) stratified by race. Multivariate Cox proportional hazards model was applied to determine predictors of OS and PFS. A p-value &lt; 0.05 was deemed statistically significant. Results: Of 194 patients who met the eligibility criteria, 42.3% were Black (n=82). On Kaplan-Meier analysis, there was no difference in median PFS (6.30 versus 7.90 months; log-rank p=0.977) and OS (9.50 versus 11.77 months; log-rank p=0.457) between White and Black patients respectively. On multivariate analysis, there was no difference in PFS (HR: 0.98; 95% CI: 0.68,1.43; p=0.928) or OS (HR: 1.01; 95% CI: 0.67,1.51; p=0.969) when controlling for race, sex, age at diagnosis, pack years, marital status, insurance type, histology, and Charlson Comorbidity Index (CCI). The most frequently administered ICIs were pembrolizumab (74.7%), nivolumab (13.4%), atezolizumab (8.8%), nivolumab plus ipilimumab (1.5%), and durvalumab (1.5%). There was no difference in treatment selection between Black and White patients (p=0.184; chi-square). Median time to initial overall cancer treatment initiation (28.00 days versus 22.00 days; p=0.159) did not differ, but there was a significant difference in median time to immunotherapy initiation (34.00 versus 27.00 days; p=0.042) between White and Black patients respectively. Conclusion: Although race was expected to permeate patient outcomes, OS and PFS did not differ between Black and White patients. The significantly shorter time to immunotherapy treatment for Black patients is an unexpected finding. In our study we highlighted that equitable access reduces disparities, bridges gaps in care, and improves patient outcomes, regardless of race. Further studies with equitable representation of diverse racial groups are warranted to better understand how race impacts cancer outcomes.
Citation Format: Melisa Pasli, Radhamani Kannaiyan, Praveen Namireddy, Mahvish Muzaffar. Impact of race on the outcomes of advanced stage non-small cell lung cancer in an equal access setting [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B127.