Persistent ethnicity-associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access

• Type of Material: Article
• Authors: Marcus A Florez, Baylor College of Medicine; Jan A Kemnade, Veterans Affairs Medical Center; Nan Chen, University of Chicago; Wendy Du, Emory University; Anita L Sabichi, Michael E. DeBakey Veterans Affairs Medical Center; Daniel Y Wang, Baylor College of Medicine; Quillan Huang, Michael E. DeBakey Veterans Affairs Medical Center; Courtney N Miller-Chism, Baylor College of Medicine; Aparna Jotwani, Baylor College of Medicine; Albert C Chen, Baylor College of Medicine; David Hernandez, Baylor College of Medicine; Vlad C Sandulache, Baylor College of Medicine
• Language: English
• Date: 2022-07-26
• Publisher: American Association for Cancer Research
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors; Published by the American Association for Cancer Research
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1158/2767-9764.CRC-21-0143
• Title of Journal or Parent Work: Cancer Research Communications
• Volume: 2022
• Keywords: head and neck cancer; lung cancer; race; immune checkpoint inhibitors
• Research Categories: Health Sciences, Oncology; Health Sciences, Radiology

Abstract

We reviewed response to immune checkpoint inhibitors (ICI) of 207 patients with diagnoses of lung or head and neck cancer treated with chemotherapy/ICI combination therapy and ICI monotherapy between 2015 and 2020 at one of three clinical pavilions associated with the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine. Two of these pavilions (Harris Health System and the Michael E. DeBakey Veterans Affairs Medical Center) serve large minority populations and provide equal access to care regardless of means. 174 patients had a diagnosis of lung cancer (non-small cell or small cell) and 33 had a diagnosis of head and neck squamous cell carcinoma (HNSCC). 38% self-identified as Black, 45% as non-Hispanic White, and 18% as Hispanic. The objective response rate (ORR) was similar for lung cancer (35.057%) and HNSCC patients (30.3%) (p=0.894). The ORR for Hispanic and Black patients was lower compared to non-Hispanic White patients (H 27.0%, B 32.5%, W 38.7%; H vs. W p=0.209; B vs. W p=0.398). When considering only patients treated with ICI monotherapy, the ORR for Hispanic patients dropped further to 20.7% while the ORR of Black and non-Hispanic White patients remained about the same (B 29.3% and W 35.9%, H vs. W p=0.133; B vs. W p=0.419). Immune related adverse events were the lowest in the Hispanic population occurring in only 30% of patients compared to 40% of patients in the Black cohort and 50% of the non-Hispanic White cohorts.