Real-World Evaluation of Racial and Socioeconomic Disparities in Patients With NSCLC Treated With Immunotherapy

Authors Rivers, Zachary, Nimeiri, Halla, Hyun, Seung Won, PhD, Charlot, Marjorie, Fuchs, Joseph, Dressler, Danielle, Ben-Shachar, Rotem, Patel, Jyoti


Black and/or socioeconomically disadvantaged patients with advanced Non-Small Cell Lung Cancer (NSCLC) have higher mortality rates than non-Black and/or socioeconomically advantaged patients. Several studies have demonstrated that social and structural determinants of health, such as racism and access to healthcare contribute to racial health disparities. This study is the first to evaluate all-cause mortality by race and area deprivation index (ADI), a measurement of socioeconomic advantage, in a real-world NSCLC cohort treated with FDA-approved immunotherapy in the first-line setting.

Methods: This retrospective analysis examined patients with NSCLC from the Tempus database who received Tempus xT genomic profiling prior to treatment with FDA-approved immunotherapy, and had PD-L1 tumor proportion score ≥ 1% and/or tumor mutational burden result ≥ 10. Two predictor variables were analyzed: race (Black vs. Non-Black), and ADI: ADI-L: ADI < 57 (the median in our dataset) and ADI-H (ADI ≥ 57), with ADI-L representing higher socioeconomic advantage. Cox proportional hazards models were fit evaluating the relationship between race, ADI and real-world overall survival (rwOS).

Results: The cohort consisted of 189 patients: 22(11.6%) Black and 167 (88.4%) non-Black. There were 123 patients with ADI data. Demographic and clinical characteristics patients were well-balanced, with the exception of ADI, with Black patients having a higher median ADI than non-Black patients (ADI = 73 vs 51, p = 0.002). The univariate analyses showed no statistically significant differences in rwOS by self-reported race or ADI (Table 1).

Conclusions:  This study is the first real-world cohort analysis demonstrating that in patients with NSCLC who underwent broad molecular testing and then were treated with first-line immunotherapy, there were no significant differences in rwOS by race or area deprivation. Future work should examine improved access to biomarker testing and guideline-concordant therapy on mitigating racial and socioeconomic health disparities.

Predictor Variables Category (N) HR p-value Median OS (95% CI) (months)
Race Non-Black (167) 17.5 (13.4-32.7)
Black (22) 0.60 0.23 29.2 (17.4-NR)
ADI ADI-L (62) 17.1 (11.0-NR)
ADI-H (61) 0.93 0.75 17.6 (12.0-NR)
NA (66)