OBJECTIVES: Immunotherapy has gained widespread use in the management of patients with Non-Small Cell Lung Cancer (NSCLC). Studies assessing patterns and benefits of immunotherapy use across races and ethnicities are limited. The objective of this study was to investigate the prevalence of immunotherapy use across racial and ethnic groups and to assess the role of race and ethnicity on survival outcomes of patients with NSCLC in Texas treated with immunotherapy.

METHODS: In this retrospective cohort study, patients with NSCLC receiving immunotherapy from 2009 to 2018 were identified in the Texas Cancer Registry (TCR) database. Proportion of patients receiving immunotherapy was determined and the change in rate of use was estimated across races. Racial differences in cancer-specific survival were evaluated using Kaplan-Meier method, log rank test and multivariable Cox proportional hazard regression models.

RESULTS: In patients diagnosed with NSCLC from 2009 to 2018 (N=106,985), use of immunotherapy increased by 18-fold in Asians, 11-fold in Non-Hispanic Blacks (NHB), 10-fold in Hispanics, 8-fold in Non-Hispanic Whites (NHW), and 2-fold in Native American and Native Hawaiians combined. Survival analysis cohort included 737 patients with complete histopathological data and comprised of NHW (75%), NHB (12%), Hispanics (10%) and Asians (3%). Although differences in survival rate were not statistically different across racial groups, median survival time was 30 months for Asians (95% confidence interval, CI: 18-not estimable), 16 months for NHB (95% CI: 11-34), 16 months for Hispanics (95% CI: 12-26), and 16 months for NHW (95% CI: 13-18).

CONCLUSION: This study revealed increasing use of immunotherapy across races in Texas and the greatest increase was observed in Asian. Although not significant in our study, further research is needed to evaluate why Asians had almost double the median survival rate as compared to NHB, NHW, and Hispanics.