Immune Checkpoint Inhibitor Outcomes in NSCLC Across Populations and Practice Settings

Immune checkpoint inhibitor (ICI) clinical trials generally enroll non-Hispanic White patients at academic or private practice settings. ICI outcomes at safety-net settings and across diverse populations remain limited.

We conducted a retrospective study of patients with advanced NSCLC treated in a safety-net health care system and at an academic cancer center. We obtained clinical and demographic data from the electronic medical record. Kaplan-Meier estimates and Cox proportional hazards model were used to assess variables associated with survival.

A total of 408 patients were included. Compared with the academic center cohort (n = 213), the safety-net cohort (n = 195) was younger (35% versus 75% ≥ 65 y old; p < 0.001), had more racial and ethnic diversity (48% versus 73% non-Hispanic White; p < 0.001), and had more disadvantaged socioeconomic score (61 versus 24 median socioeconomic index; p < 0.001). After multivariable adjustment, patients receiving ICI as part of their treatment had improved survival compared with patients receiving chemotherapy alone (chemoradiation and ICI: adjusted hazard ratio [aHR] = 0.54; 95% confidence interval [CI]: 0.31-0.93; p = 0.03; chemotherapy and ICI: aHR = 0.44; 95% CI: 0.28-0.68; p < 0.001; ICI alone: aHR = 0.53; 95% CI: 0.30-0.91; p = 0.02). There was a near significant association with improved survival at academic practice setting (HR = 0.77; CI = 0.58-1.03; p = 0.08). There were no differences in survival according to race and ethnicity or socioeconomic status.

In a diverse cohort across practice settings, receipt of ICI was associated with improved survival, regardless of facility type, race and ethnicity, or socioeconomic status. Efforts to provide ICI access to all eligible patients may improve outcomes.