Black patients with cutaneous T-cell lymphoma (CTCL) and their likelihood to receive novel agents: A retrospective cohort analysis.

Abstract

e13822 Background: Black patients with cutaneous T-cell lymphoma (CTCL) have increased risk of mortality compared to other racial groups. The introduction of novel therapies such as mogamulizumab and brentuximab vedotin (BV) for the treatment of CTCL have demonstrated improved survival compared to standard therapies. We investigated treatment patterns including receipt of novel agents among patients with CTCL to better understand the role of treatment selection as a potential driver of racial disparities. Methods: We performed a retrospective review of 315 patients with a histopathologic diagnosis of mycosis fungoides (MF), Sezary syndrome (SS), or CTCL not otherwise specified (NOS) seen at the Winship Cancer Institute of Emory University from 2000-2023. Clinical data was collected from the electronic medical record and included demographics, histopathologic findings, treatments received, highest disease stage reached, and survival. Systemic therapies were divided into three groups: standard chemotherapy (single agent or multi agent), biologics (interferon, retinoids, extracorporeal photopheresis, and oral methotrexate), and novel agents (mogamulizumab, BV, and clinical trials). The association between overall survival (OS) and race, stage, and treatment category was assessed using univariate and multivariable analysis for significant factors and patients were matched according to age and stage. Results: The cohort was comprised 53.6% of patients identifying as Black (n = 169) and 46.4% white (n = 146). Males made up 57.8% (n = 182) of the cohort and females 42.2% (n = 133). Median age at diagnosis was 59.5 years (range, 12-91). Black patients had an earlier age of diagnosis compared to white (median 50 years vs. 63, p < 0.001). The majority of patients had a pathological diagnosis of MF (n = 246, 78.1%), followed by 18.1% SS (n = 57) and 3.8% CTCL NOS (n = 12). Insurance status included private in 50.3% of patients (n = 157), 38.1% Medicaid/Medicare (n = 119), 4.8% uninsured (n = 15) and 6.7% other (n = 21). 53.4% of patients had advanced-stage disease of 2b or higher at time of diagnosis. In the unmatched cohort, Black patients were more likely to receive novel agents compared to white patients (30.8% vs. 19.2%, p = 0.018). However, after matching by age and disease stage, black patients were less likely to receive novel agents (p = 0.019). There were no significant differences in the receipt of biologics or chemotherapy agents. Patients with advanced stage disease had improved OS if they received novel agents (HR 0.39, 0.24-0.65, p < 0.001). Conclusions: Receipt of novel agents was associated with improved survival. Black patients were less likely to receive novel agents when matched for age and disease stage. These findings suggest that treatment patterns, such as the receipt of novel agents, could play a role in the racial differences in clinical outcomes in CTCL.