Trends in immunotherapy utilization among older adults with advanced endometrial cancer: An NCDB analysis

To examine temporal trends in immunotherapy (IO) adoption and identify factor-related disparities among older adults with advanced endometrial cancer (EC).

We conducted a retrospective cohort study using the National Cancer Database (NCDB), including women aged ≥65 years diagnosed with stage III-IV EC between 2019 and 2023. Temporal trends of IO use were assessed, and multivariable logistic regression identified predictors of IO utilization.

Among 38,931 patients with advanced EC, 21,272 (54.6%) were aged ≥65 years. IO utilization increased significantly over time across all age groups (P-trend <0.001). By 2023, 1851 older adults (40%) received IO, but utilization remained substantially lower among patients aged ≥85 years (55/255, 21.6%; P < 0.001). On multivariable analysis, patients aged ≥85 years were significantly less likely to receive IO compared with those aged 65-74 years (adjusted odds ratio [aOR] 0.41; 95% CI, 0.32-0.52; P < 0.001). Non-Hispanic (NH)-Black (aOR 0.81; 95% CI, 0.73-0.90; P < 0.001) and Hispanic patients (aOR 0.84; 95% CI, 0.71-0.99; P = 0.034) were also less likely to receive IO compared with NH-White patients. After adjustment for socioeconomic factors, NH-Black was 12% less likely to receive IO (aOR 0.88; 95% CI, 0.77-0.99; P = 0.0034).

Despite the proven clinical benefit of IO use for patients with advanced EC, substantial age-based disparities persist. A lower likelihood of IO receipt among NH-Black compared with NH-White patients was also observed even after adjustment for socioeconomic factors. These findings highlight the need for further investigation into clinical, socioeconomic, and structural barriers influencing treatment access in older and minoritized populations.