NSCLC: Racial and Socioeconomic Disparities in Survival Rates
—Certain vulnerable groups of patients with metastatic non-small cell lung cancer are in need of more-creative strategies to increase their rates of survival. Read on to learn the details.
For patients with non-small cell lung cancer (NSCLC) and the clinicians who treat them, good news in recent years has come in the form of new classes of effective therapeutic agents, like tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs).
According to the investigators of a newly published study, survival among patients with metastatic NSCLC (mNSCLC) has improved dramatically.1 ICI therapy with or without platinum-based chemotherapy is now the recommended option for older individuals who carry tumors with no known driver mutation. However, there’s a lack of data on the use of ICIs in different demographic populations.1
.jpg)
Assembling the study cohort
To learn more about this topic, a team of researchers at Wayne State University, in Detroit, tapped the Surveillance, Epidemiology, and End Results (SEER)-Medicare database.1 According to the authors, the SEER program, which is sponsored by the National Cancer Institute, consists of high-quality cancer registries and is the only source for population-based cancer data in the U.S. that includes patient survival information. The purpose of the study was to examine whether there are racial or socioeconomic differences in ICI treatment uptake and corresponding survival.
In total, the investigators identified 17,134 patients who were diagnosed with mNSCLC between January 2015 and December 2019. Participants were a median age of 74 years old. More than 4 in 5 (81.3%) were White; 82.7% lived in a metropolitan area; and 60.7% had adenocarcinoma histology.
The receipt of an ICI and overall survival (OS) were the primary outcomes of the study.
Who’s benefiting most from ICI therapy?
The investigators found that approximately 39% of patients received an ICI within the study period, with the odds of this increasing if they were diagnosed more recently, from 21.9% in 2015 to 55.4% in 2019 (P<.001). They were also more likely to be given an ICI if they were younger than 85 years old; non-Hispanic White, non-Hispanic Asian, or Hispanic; living in high socioeconomic status (SES) or metropolitan areas; or not eligible for Medicaid. Those with adenocarcinoma histology were also more likely to receive an ICI.
Roughly 1 in 4 non-Hispanic Blacks (28.5%) and American Indian/Alaska natives (24.6%) received ICIs, compared to 40.2% of non-Hispanic White patients and 34.0% of Hispanics.
The overall population had a median OS of 7 months. The 1-year and 2-year OS rates were
34% and 21%, respectively. Non-Hispanic Whites and non-Hispanic Asians had 2-year survival rates of 22% and 23%, respectively, compared to 15% and 17% in non-Hispanic Blacks and Hispanics.
For patients who initiated at least 1 cycle of ICI treatment, 2-year OS was 30%, compared to just 11% for those who weren’t given an ICI. Moreover, for patients who didn’t receive ICI treatment, the median OS was 4 months; 1-year OS was 19.5%, 2-year OS 11.4%. Asian, White, Black, and Hispanic patients not on ICI therapy had 2-year OS rates of 14%, 12%, 9%, and 9%, respectively.
Limitations and conclusions
Despite several interesting findings, this study, like most, had a few limitations. For one, it was an observational cohort study, with a possibility that some patients with more-aggressive disease may have died before ICI treatment could be started. Another study limitation is that the SEER-Medicare database includes only patients who are 65 and older, so the study results may not accurately reflect outcomes in younger NSCLC patients.
Additionally, patient-level data (performance status, comorbidities, type of ICI treatment, or history of autoimmune disease) weren’t included but are important predictors of NSCLC outcomes and serve as factors in the selection of patients for ICI therapy. Lastly, there was no insight into the treatment decision-making process in the SEER-Medicare cohort in terms of patient preference or other barriers to treatment initiation.
Still, for cancer teams there are many important take-aways, says the study’s lead investigator, Dipesh Uprety, MD, of the Karmanos Cancer Institute at Wayne State. “Our study demonstrated that patients with low SES and living in low-income neighborhoods were less likely to receive immune checkpoint inhibitors, leading to an inferior outcome,” he notes. “
“The negative impact on survival outcomes among these vulnerable groups,” Dr. Uprety concluded, “should alert policymakers to develop targeted health interventions to increase access to care.”
Published:
References
.jpg)
