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Black Patients With Advanced NSCLC Receiving Immunotherapy May Have a Lower Risk of Death Than White Patients


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Collectively, Black Americans have the highest death rate and shortest survival of any racial/ethnic group in the United States for most cancers; Black men also have the highest cancer incidence rate. Despite improvements in survival disparities between Black and White Americans in specific cancers like lung cancer, Black men and women still have lower survival rates than White men and women—16.1% and 24.1% vs 18.5% and 25.5%, respectively.

However, while Black patients with lung cancer experience higher mortality rates from lung cancer than their White counterparts, a new study by Akinyemiju et al has found that equal access to immunotherapy may help to close the survival gap. According to the study results, among patients with advanced stage non–small cell lung cancer (NSCLC) who received immunotherapy, non-Hispanic Black patients experienced a 15% lower risk of death compared with non-Hispanic White patients. The study is being presented at the virtual 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

Study Methodology

The researchers obtained data from the 2016 National Cancer Database on 3,068 patients with advanced NSCLC who were treated with immunotherapy. They used multivariable Cox proportional hazards models to calculate hazard ratios and 95% confidence intervals by race/ethnicity. In addition, the researchers evaluated the interaction of race/ethnicity with Charlson-Deyo comorbidity score and area-level median income using stratified models and formal tests of interaction.

KEY POINTS

  • Among patients with advanced-stage NSCLC who received immunotherapy, non-Hispanic Black patients experienced a 15% lower risk of death compared with non-Hispanic White patients.
  • Black patients receiving immunotherapy living in the lowest two quartiles of median income had a 18% lower risk of death than White patients.

Results

After adjusting the survival data for sociodemographic factors—including age, sex, location, and income—as well as tumor characteristics and the type of treatment received, the researchers found that non-Hispanic Black patients had a 15% lower risk of death compared with non-Hispanic White patients (hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.59–0.98). The researchers’ analysis also showed that non-Hispanic Black immunotherapy recipients living in counties in the lowest two quartiles of median income had an 18% lower risk of death compared with non-Hispanic White immunotherapy recipients at the same income level (HR = 0.82, 95% CI = 0.69–0.98). In addition, the study found that among immunotherapy-treated patients with at least one comorbidity, Black patients experienced a 24% lower risk of death compared to White patients.

“Among [patients with] advanced-stage NSCLC who received immunotherapy, non-Hispanic Black patients experienced higher survival compared to non-Hispanic 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,” concluded the study authors.
Limitations of the study include a lack of data on the smoking status of the patients, as well as limited data on the types and severity of the comorbidities used to stratify the data.

“Making sure everyone has access to the best treatment facilities and providers so they can benefit from groundbreaking novel therapies will be essential to reduce cancer burden,” said Tomi Akinyemiju, PhD, Associate Professor in Population Health Sciences at Duke Cancer Institute and lead author of this study, in a statement.

Disclosure: The study was funded by the Duke University School of Medicine. Dr. Akinyemiju declared no conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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