Impact of ethnicity and insurance on adverse effects and treatment outcomes related to immune checkpoint inhibitors at a safety net hospital.

person Himil Mahadevia University of Missouri–Kansas City, Kansas City, MO info_outline Himil Mahadevia, Benjamin Eidenschink, Stephanie Sarita Harry, Lara Ann Kujtan

Authors person Himil Mahadevia University of Missouri–Kansas City, Kansas City, MO info_outline Himil Mahadevia, Benjamin Eidenschink, Stephanie Sarita Harry, Lara Ann Kujtan Organizations University of Missouri–Kansas City, Kansas City, MO, University of Missouri Kansas City (Kansas City, MO), Kansas City, MO, University of Missouri Kansas City, Kansas City, MO, University of Missouri - Kansas City, Kansas City, MO Abstract Disclosures Research Funding No funding received None. Background: Clinical trials have shown efficacy and safety of immune checkpoint inhibitors (ICI) in the treatment of various malignancies. However, trial populations often do not adequately represent patient populations in the real-world. We report immune related adverse effects (IRAEs) among patients with various malignancies, diverse ethnicities, and government sponsored insurance or uninsured, as well as treatment outcomes of ICIs in metastatic non-small cell lung cancer (mNSCLC). Methods: A retrospective study of adult patients with malignancy, who received ICI or ICI plus chemotherapy from January 1, 2015 to January 1, 2020 was conducted at a safety net hospital. Data was collected from electronic medical records with IRB approval. IRAEs were identified and categorized according to CTCAE v5.0. 1-year overall survival (OS) and median duration of ICI therapy (mDT) were calculated for mNSCLC patients. Results: We reviewed 121 patients: 49% were African American (AA), 40% were white and 11% were other ethnicities. Medicaid/Medicare (M/M) was the primary insurance for 83% of patients, 6% had commercial insurance and 11% were uninsured. The median duration of follow-up was two years. IRAEs occurred in 37% of patients; hypothyroidism was the most common (7.5%), and none led to death. The incidence of grade 2 or higher IRAEs was lower in AA (25.4%) compared to in whites (32.6%), with treatment discontinuation rates of 5% in AA versus 16% in whites. Among mNSCLC patients, AA and other ethnicities had a decreased 1-year OS of 37% and 22% respectively, compared to 48% in whites. The mDT was 8.3 months for AA and 3 months for other ethnicities, compared to 13.2 months for whites. 40% of M/M patients with mNSCLC were alive at 1 year; none of the uninsured patients were alive at 1 year. The mDT was higher in M/M patients (6 months) than uninsured patients (3.5 months). Conclusions: Ethnicity and insurance coverage may influence the incidence of IRAEs and treatment outcomes with ICI. AA had a lower incidence of IRAEs compared to whites. However, minority populations with mNSCLC had decreased survival compared to whites. mNSCLC patients with M/M had better OS than uninsured patients. Minorities and uninsured patients spent less time on ICI compared to other patients. IRAEs are a significant burden and further study of the use of ICIs in diverse populations is warranted. Immune checkpoint inhibitor use stratified by ethnicity. African American (59) White (49) Other (13) Commercial Medicare/Medicaid Uninsured 2 52 5 3 41 5 2 8 3 Metastatic non-small cell lung cancer (NSCLC) Other* 38 21 31 18 9 4 Grade 2 or > Toxicity 25.4% (15) 32.6% (16) 23% (3) p = 0.19 Median duration of treatment in metastatic NSCLC (months) 8.3 13.2 3.0 p = 0.12 Overall survival of metastatic NSCLC at 1 year 37% (14) 48% (15) 22% (2) p = 0.15 *Includes melanoma, small cell lung, renal cell, head and neck, and gynecologic cancers.