CN28 - Racial disparities in immune-related adverse events in patients with lung cancer treated with immune checkpoint inhibitors

Background

Immune-checkpoint-inhibitors (ICIs) have revolutionized the treatment approaches and 5-year-surival of patients (pts) with lung cancer. They cause various irAEs, and the incidence can vary across different cancer subtypes and across combination regimens. Prior clinical trials with ICIs have underrepresented minorities with <5% African Americans (AA).

Methods

Using ICD-10, we identified pts with lung cancer hospitalized from 2016-2020 from the ‘National Inpatient Sample (NIS)’ database. We evaluated for all-cause in-hospital mortality (ACIHM) and for the occurrence of irAEs, including immune hepatitis, hypothyroidism, adrenal insufficiency, encephalitis/myelitis. Demographics, comorbidities, irAEs were studied using chi-square for categorical or ANOVA for continuous data (statistical significance p-value < 0.05).

Results

1,961,429 pts with lung cancer- 77.39% were white (W), 12.6% African-American (AA), 4.6% Hispanic, 2.88% Asian/Pacific Islanders, 0.38 % Native Americans, and 2.12% other races. ACIHMc had high aOR of 1.22 (95% CI 1.14-1.31, p<0.001) as compared to white pts. When compared to white pts, pts of other races had a higher aOR for ACIHM at 1.24 (95% CI 1.14-1.34, p<0.001). Hypothyroidism in AA pts had lower aOR of 0.65 (95% CI 0.43-0.98, p 0.042) as compared to white pts. Adrenal insufficiency and immune hepatitis in the AA pts had significantly lower aORs as compared to whites, at 0.63 (95% CI 0.43-0.91, p 0.016) and 0.67 (95% CI 0.45-0.99, p 0.049) respectively. Encephalitis/myelitis in AA pts also had lower aOR of 0.56 (95% CI 0.32-0.99, p 0.047) as compared to whites. Acute drug-induced ILD and unspecified ILD had higher aORs in Asian/Pacific Islanders as compared to white pts, at 1.68 (95% CI 1.06-2.66, p 0.025) and 1.78 (95% CI 1.37-2.31, p<0.001) respectively.

Conclusions

This study highlights the racial and ethnic disparities that exist within the lung cancer population. There is underrepresentation of minorities within clinical trials involving ICIs. Asian/Pacific Islanders exhibiting higher odds of ACIHM, acute and unspecified drug-induced ILDs. Race and ethnicity may be potential surrogates and predictors, pending replication of these results in large-scale studies.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.