Racial Disparities in Biomarker Testing Rate, First-Line (1L) Treatment Patterns and Clinical Outcomes Among Real-World Patients in the United States (US) with Advanced or Metastatic Non-Small Cell Lung Cancer (mNSCLC)
Author(s)
Makenzi Evangelist, MD1, Shilpa Viswanathan, PhD2, Shivani K. Mhatre, PhD2, Indy Dhillon, PhD2, Ravi Gupta, PhD2, Christine Bestvina, MD3.
1Albany Cancer Center, Albany, NY, USA, 2Gilead Sciences, Foster City, CA, USA, 3University of Chicago Medicine, Chicago, IL, USA.
1Albany Cancer Center, Albany, NY, USA, 2Gilead Sciences, Foster City, CA, USA, 3University of Chicago Medicine, Chicago, IL, USA.
Presentation Documents
OBJECTIVES: Current population-based racial disparity studies in mNSCLC suggest that while disparities exist in access to treatment, there is mixed evidence on the effect on outcomes following 1L treatment receipt. This study compared PD-L1 testing rates, 1L treatment choice and clinical outcomes by racial groups in 1L-treated patients with mNSCLC in the US.
METHODS: Data were obtained by retrospective analysis of the nationwide Flatiron Health electronic health record-derived deidentified database. Patients had a diagnosis of mNSCLC and received 1L treatment between 01Jan2020-30Dec2023 (data cutoff: 31Jul2024). Real-world overall survival (rwOS), time-to-treatment discontinuation (rwTTD), and time-to-next-treatment (rwTTNT) were calculated using the Kaplan-Meier method. Adjusted Cox models were used to compare outcomes between racial groups.
RESULTS: Of 7932 eligible patients, 5080 (64.0%) were White, 883 (11.1%) Black, 152 (1.9%) Asian, and 1817 (22.9%) other/missing race classification. PD-L1 testing rate was similar for Blacks (58.2%) and Whites (57.8%). Similar 1L treatment choices were observed for immunotherapy (IO) - mono (15.5% vs. 19.0%), chemotherapy (CT) (36.4% vs. 35.5%), and IO + CT combination therapy (45.8% vs. 42.5%) between Blacks and Whites, respectively. Outcomes for median rwTTD (4.6 vs. 4.2) and median rwTTNT (7.9 vs. 7.3) were similar in Blacks and Whites, respectively, and median rwOS (15.5 vs. 12.8) was better in Blacks compared with Whites. Asians showed improved outcomes compared with both, but interpretation was inconclusive due to limited sample size. Adjusted Cox model estimates showed similar rwOS (HR, 95% CI: 0.87, 0.78-0.96), rwTTD (0.90, 0.82-0.97), and rwTTNT (0.89, 0.82-0.98) outcomes in Black and White patients.
CONCLUSIONS: In this cohort of patients with mNSCLC with access to 1L treatments, there were similarities in PD-L1 testing rate, 1L treatment choice, and real-world outcomes between White and Black patients. This highlights the need for equitable access to 1L treatment to minimize racial disparities.
METHODS: Data were obtained by retrospective analysis of the nationwide Flatiron Health electronic health record-derived deidentified database. Patients had a diagnosis of mNSCLC and received 1L treatment between 01Jan2020-30Dec2023 (data cutoff: 31Jul2024). Real-world overall survival (rwOS), time-to-treatment discontinuation (rwTTD), and time-to-next-treatment (rwTTNT) were calculated using the Kaplan-Meier method. Adjusted Cox models were used to compare outcomes between racial groups.
RESULTS: Of 7932 eligible patients, 5080 (64.0%) were White, 883 (11.1%) Black, 152 (1.9%) Asian, and 1817 (22.9%) other/missing race classification. PD-L1 testing rate was similar for Blacks (58.2%) and Whites (57.8%). Similar 1L treatment choices were observed for immunotherapy (IO) - mono (15.5% vs. 19.0%), chemotherapy (CT) (36.4% vs. 35.5%), and IO + CT combination therapy (45.8% vs. 42.5%) between Blacks and Whites, respectively. Outcomes for median rwTTD (4.6 vs. 4.2) and median rwTTNT (7.9 vs. 7.3) were similar in Blacks and Whites, respectively, and median rwOS (15.5 vs. 12.8) was better in Blacks compared with Whites. Asians showed improved outcomes compared with both, but interpretation was inconclusive due to limited sample size. Adjusted Cox model estimates showed similar rwOS (HR, 95% CI: 0.87, 0.78-0.96), rwTTD (0.90, 0.82-0.97), and rwTTNT (0.89, 0.82-0.98) outcomes in Black and White patients.
CONCLUSIONS: In this cohort of patients with mNSCLC with access to 1L treatments, there were similarities in PD-L1 testing rate, 1L treatment choice, and real-world outcomes between White and Black patients. This highlights the need for equitable access to 1L treatment to minimize racial disparities.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR117
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
SDC: Oncology