P40.16 Real-World Data and Racial Outcomes for NSCLC in The Chemo-Immunotherapy Era

Abstract

Lung cancer remains the leading cause of cancer death among both men and women. Recent pivotal trials established combination chemo-immunotherapy (IO) as the standard of care for advanced non-small cell lung cancer (NSCLC) without any targetable mutations. Unfortunately, minorities continue to make up less than 10% of patients enrolled in clinical trials. This means that the survival data reported in trials may or may not accurately reflect outcomes in a racially heterogenous population such as the state of Louisiana. We retrospectively collected data from patients with advanced NSCLC treated with chemo-IO between January 2014 and January 2020 through our healthcare system Ochsner Health. Primary objectives were overall survival (OS) and progression free survival (PFS). Progression was defined per RECIST v1.1. Kaplan-Meier survival analysis was utilized to estimate PFS and OS. Survival curves were compared between the race strata using the log-rank test. We identified 264 patients with stage IV NSCLC who received chemo-IO. Median age was 65. 70% were white and 27% were black. 77% had adenocarcinoma and 20% had squamous cell carcinoma. 20% had brain metastases at diagnosis. 35%, 28% and 22% had a tumor proportion score of <1%, 1-49% and >50%, respectively. Probability of PFS at 12 and at 24 months was 0.61 (0.54-0.67) and 0.40 (0.32-0.48) respectively. Median PFS was 15.3 (13.2-18.9) months. Probability of OS at 12 and at 24 months was 0.61 (0.55-0.67) and 0.37 (0.29-0.44) with a median OS of 16.8 months (14.7-20.2). Median PFS among black and white patients was 21.9 (12.3-not estimable (NE)) and 15 (12.4-17.5) months, respectively (p= 0.135). Median OS among black and white patients was 20.2 (13.4-NE) and 16.2 (12.2-19.9) months, respectively (p= 0.114). Only 45 patients (17%) were able to receive 2nd line therapy. PFS and OS data for patients with stage IV NSCLC treated with chemo-IO reported in this study were not widely different from that data reported in prospective clinical trials. In the real world, delta between PFS and OS was much closer than in the clinical trials for stage IV NSCLC, with minority of patients going on to second line. Both PFS and OS were numerically superior in black patients compared to white patients, although the difference was not statistically significant. Further prospective studies with increased minority enrollment should be conducted to further evaluate any potential racial differences for patients with NSCLC on a larger scale.