Socioeconomic influence of insurance coverage and ethnicities on efficacy outcomes and side effects related to immune checkpoint inhibitors in non-small cell lung cancer.

Abstract

168 Background: Immune checkpoint inhibitors (ICI) are approved for treatment of various malignancies. However, ethnic minorities and underprivileged patient populations are often not adequately represented in clinical studies. We hereby delineate updated data on efficacy outcomes and immune-related adverse effects (IRAEs) among patients with advanced non-small cell lung cancer (aNSCLC) belonging to diverse ethnicities, and government sponsored (Medicare/Medicaid-MM) vs commercial insurance (COI) vs uninsured (UNI). Methods: A retrospective study of adult patients who received ICI or ICI plus chemotherapy was conducted at an urban safety net hospital. The timeline was expanded from January 2015 to June 2022. Data was collected from the electronic medical record with IRB approval. All grade (CTCAE v5.0) IRAEs were identified. Progression at 1 year (1y-PFS) in addition to survival at 1-year (1y-OS) from ICI initiation was calculated for aNSCLC patients using RECIST 1.1. Chi-square analysis and ANOVA testing were utilized to determine statistical significance. Results: 291 patients were identified with ICI use. 104 patients had aNSCLC and had follow up for at least 1 year. This aNSCLC population had 42 African American (AA) and 62 Caucasian patients (CC). 79 patients had MM, 24 possessed COI and 7 were UNI. AA patients with aNSCLC had poorer 1y-OS at 44% (p=0.12) and 1y-PFS at 15% (p=0.0005) compared to CC patients which had 1y-OS of 61% and 1y-PFS of 51%. CC patients had more all grade IRAEs (42.4%) in comparison to AA patients (36.2%) (p=0.58). 1y-PFS and 1y-OS were 39% and 67% respectively in COI patients compared to MM patients who had 38% and 50% (p=0.51 and p=0.46 respectively). Self-pay had the worst 1y-PFS (19%) and 1-yr OS (36%). All grade IRAEs were 41% in MM patients, 40% in UNI and 35% in COI patients (p=0.68). Conclusions: This expanded study with updated data further upholds the influence of ethnicities and insurance coverage on the incidence of IRAEs and efficacy with ICI. There was a significant difference with worse outcome in AA population compared to CC with ICI use in aNSCLC. COI patients showed better outcome trend (non-significant) than patients with government sponsored insurance and uninsured patients had worst outcomes. This implies that impoverished patients and ethnic minorities may have inferior outcomes with ICI therapy. Larger population studies may provide further validation of these findings.[Table: see text]