Improvements in stage IV non-small cell lung cancer survival differ by race in the US

BackgroundThe management of non-small cell lung cancer (NSCLC) has transformed over the past decade through the development of immunotherapy and targeted therapies. Our objective was to evaluate the gains in survival in stage IV NSCLC by sociodemographic groups in the United States.MethodsPatients diagnosed with and treated for Stage IV NSCLC between 2010 and 2020 in the National Cancer Database were studied in 3 eras (2010 - 2013, 2014 - 2017, and 2018 - 2020). Unadjusted survival was assessed by Kaplan Meier and stratified cox analysis was performed to evaluate differences in survival by race and ethnicity.ResultsOverall, 374,273 patients were identified. The median survival was highest across all 3 eras for Asians (12.9, 17.0, and 22.5 months) and the lowest for American Indians/Alaskan Natives (6.9, 6.9, and 9.0 months) (Table). Survival increased for all racial/ethnicity groups across eras, consistent with the development of novel therapeutics, but with considerable differences in the proportionality of gains. For example, between era 1 and 3, Hispanics experienced an 81% increase in median survival, while American Indians/Alaskan Natives experienced a 30% increase (Table). Multivariable Cox models also demonstrated considerable variability in mortality risk over time, favoring groups other than non-Hispanic white patients with the exception of American Indians/Alaskan Natives. Table: 1378P 2010-2013 2014-2017 2018-2020 Median survival Hazard ratio/P Value Median survival Hazard ratio/P Value Median survival Hazard ratio/P Value % Difference in median survivalEra 3 &1 Asian 12.8 0.69 (<0.0001) 17.0 0.74 (<0.0001) 22.5 0.75 (<0.0001) 75% Hispanic 8.3 0.84 (<0.0001) 10.1 0.84 (<0.0001) 15.0 0.82 (<0.0001) 81% Other 7.9 0.90 (0.0006) 10.1 0.79 (<0.0001) 14 0.83 (<0.0001) 78% Native Hawaiian/Pacific Islander 8.2 0.89 (0.0891) 9.9 0.92 (0.1688) 13.5 0.92 (0.2735) 65% Non-Hispanic Black 6.7 0.96 (<0.0001) 7.8 0.92 (<0.0001) 10.3 0.91 (<0.0001) 55% American Indian/Alaskan Native 6.9 0.97 (0.5733) 6.9 1.05 (0.3819) 9.0 1.04 (0.5281) 30% Non-Hispanic White 6.6 Ref 7.4 Ref 9.6 Ref 47% ConclusionsThere has been a dramatic improvement in survival among stage IV NSCLC over the past decade across all race and ethnicity. The rates of improvement in survival were observed to differ across sociodemographic groups, with the Hispanic patients experiencing the highest benefit. Further studies to understand variability in survival gains by type of therapy or by mutation status are warranted to understand the long-term potential disparities in cancer-related mortality.Legal entity responsible for the studyD. Boffa.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.