REAL-WORLD HEALTH DISPARITIES IN TIME TO NEXT TREATMENT FOLLOWING FIRST-LINE THERAPY FOR ADVANCED AND RECURRENT ENDOMETRIAL CANCER IN THE UNITED STATES
Author(s)
Angela K. Green, MD1, Hanwen Zhang, MS2, Kathleen M. McClain, PhD3, Vimalanand S. Prabhu, PhD3, Ke Meng, PhD3, Srujitha Marupuru, MS, PharmD, PhD3, Vy Tran, MHS3, Robin Meng, MD, PhD3, Kristina Woodhouse, MD3, Kaushal D. Desai, PhD3, Christian Marth, MD4, Vicky Makker, MD1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2University of Texas at Austin, Austin, TX, USA, 3Merck & Co., Inc., Rahway, NJ, USA, 4Medical University Innsbruck, Innsbruck, Austria.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2University of Texas at Austin, Austin, TX, USA, 3Merck & Co., Inc., Rahway, NJ, USA, 4Medical University Innsbruck, Innsbruck, Austria.
OBJECTIVES: Endometrial cancer incidence in the US has been rising, with Black women bearing a disproportionate burden, including increased mortality, compared with White women. We assessed differences in real-world time to next treatment (rwTTNT), a surrogate for progression-free survival, to understand disparities in treatment effectiveness by race.
METHODS: This retrospective study used the US-based Flatiron Health database (2013-2025), including women aged ≥18 with advanced or recurrent endometrial cancer receiving first-line (1L) therapy. rwTTNT (time from 1L initiation to 2L initiation) was used as a surrogate endpoint for real-world progression-free survival. Time ratios (TR) for rwTTNT were estimated using log-normal accelerated failure time models. Covariates included: race, ethnicity, age, BMI, geographic region, insurance status, socioeconomic status, practice setting, Charlson comorbidity index, histology, recurrent/de novo status, ECOG performance score, MMR/MSI status, and 1L initiation before/after 2023 NCCN guidelines update.
RESULTS: Among 3,217 patients (59% White, 18% Black, 2% Asian, 21% Other/Unknown; median age 67), Black women had a greater proportion of patients with lower SES, non-endometrioid histology, pMMR tumors, and advanced diagnoses compared to White women. After adjustment, Black women had significantly shorter rwTTNT, a 15% lower time to 2L compared to White women (TR=0.85 [0.74-0.99]). Shorter rwTTNT was also associated with worse ECOG (2-4: TR=0.55 [0.47-0.65] vs. 0-1), non-endometrioid histology (serous carcinoma: TR=0.81 [0.71-0.92], carcinosarcoma/MMT: TR=0.67 [0.57-0.80], endometrial cancer NOS: TR=0.77 [0.65-0.92] vs. endometrioid), and pMMR/MSS (TR=0.80 [0.68-0.95] vs. dMMR/MSI-H). Overweight and obesity were associated with longer rwTTNT (overweight: TR=1.27 [1.09-1.48], obesity: TR=1.24 [1.08-1.42] vs. normal).
CONCLUSIONS: Racial disparities in rwTTNT persisted in endometrial cancer: Black women initiated 2L sooner, indicating faster progression following 1L, despite controlling for known risk factors. Addressing underlying causes can help improve risk stratification, guide equitable treatment, and reduce disparities among women with endometrial cancer.
METHODS: This retrospective study used the US-based Flatiron Health database (2013-2025), including women aged ≥18 with advanced or recurrent endometrial cancer receiving first-line (1L) therapy. rwTTNT (time from 1L initiation to 2L initiation) was used as a surrogate endpoint for real-world progression-free survival. Time ratios (TR) for rwTTNT were estimated using log-normal accelerated failure time models. Covariates included: race, ethnicity, age, BMI, geographic region, insurance status, socioeconomic status, practice setting, Charlson comorbidity index, histology, recurrent/de novo status, ECOG performance score, MMR/MSI status, and 1L initiation before/after 2023 NCCN guidelines update.
RESULTS: Among 3,217 patients (59% White, 18% Black, 2% Asian, 21% Other/Unknown; median age 67), Black women had a greater proportion of patients with lower SES, non-endometrioid histology, pMMR tumors, and advanced diagnoses compared to White women. After adjustment, Black women had significantly shorter rwTTNT, a 15% lower time to 2L compared to White women (TR=0.85 [0.74-0.99]). Shorter rwTTNT was also associated with worse ECOG (2-4: TR=0.55 [0.47-0.65] vs. 0-1), non-endometrioid histology (serous carcinoma: TR=0.81 [0.71-0.92], carcinosarcoma/MMT: TR=0.67 [0.57-0.80], endometrial cancer NOS: TR=0.77 [0.65-0.92] vs. endometrioid), and pMMR/MSS (TR=0.80 [0.68-0.95] vs. dMMR/MSI-H). Overweight and obesity were associated with longer rwTTNT (overweight: TR=1.27 [1.09-1.48], obesity: TR=1.24 [1.08-1.42] vs. normal).
CONCLUSIONS: Racial disparities in rwTTNT persisted in endometrial cancer: Black women initiated 2L sooner, indicating faster progression following 1L, despite controlling for known risk factors. Addressing underlying causes can help improve risk stratification, guide equitable treatment, and reduce disparities among women with endometrial cancer.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH27
Topic
Epidemiology & Public Health
Disease
SDC: Oncology