Impact of immunotherapy on small cell lung cancer survival: A focus on treatment setting, race, and socioeconomics.

Abstract

8102 Background: Immunotherapy has transformed the treatment landscape for many cancers, but its benefit in small cell lung cancer (SCLC) has remained modest. Trials like IMpower133 and CASPIAN demonstrated survival gains of only 2 to 2.7 months in patients with extensive-stage SCLC. However, the ADRIATIC trial highlighted significant survival benefits with durvalumab in limited-stage SCLC. Our study examines survival trends in SCLC across the pre-immunotherapy (PIE) and immunotherapy eras (IE) using National Cancer Database data, though it does not account for the recent advances in limited-stage SCLC due to the dataset being capped at 2021. Methods: Kaplan-Meier plots estimate survival probabilities, and log-rank tests compare survival between the IE (2016-2021) and PIE (2010-2015). Median overall survival (OS) and 5-year OS are reported with 95% CI, using a p-value threshold of <0.05. Cox regression analyzes the impact of demographic, clinical, and socioeconomic factors on survival, with hazard ratios (HR) indicating mortality risk. Results: This study analyzed 244,973 SCLC patients, divided into IE (n = 124,774) and PIE (n = 120,199). The majority were White (85%), with a median age of 68 years and a near-equal sex distribution (48% male, 52% female). Most patients were diagnosed at Stage IV (63%), and only 5% at Stage I. Survival rates were better in the IE (p < 0.001) except for stage IV disease. Patients treated at academic centers and Asian/Pacific Islander patients had better outcomes. Cox regression identified disease stage, immunotherapy use, facility type, insurance, and socioeconomic factors as key survival determinants. Immunotherapy improved survival, while lower income, lack of insurance, and non-academic centers worsened outcomes, highlighting the need for accessible care and financial support. Conclusions: Immunotherapy has modest improvement in survival outcomes for SCLC, but disparities in treatment access and outcomes persist across different populations. Ensuring equitable access to specialized care and financial support is essential to further improving survival rates. Category Group N Median Survival (months) 5yr OS (%) P value All stages IE 124,774 8.74 11.2 <0.001 PIE 120,199 8.48 8.3 Stage I and II IE 12,146 27.76 31 <0.001 PIE 10,559 22.01 26 Stage III IE 28,347 15.18 19 <0.001 PIE 29,288 13.67 15 Stage IV IE 79,005 6.24 5 <0.001 PIE 74,714 6.24 3 Facility Academic 33,883 9.69 13.3 <0.001 Non-Academic 90,655 8.38 10.3 Race Hispanic 3,169 9.30 14.2 <0.001 Non-Hispanic - Asian/Pacific Islander 2,242 9.86 14.5 Non-Hispanic - Black 9,786 9.95 13.8 Non-Hispanic - White 106,464 8.57 10.7 Income < $46,277 22,397 8.31 10.5 <0.001 $46,277 - $57,856 27,868 8.51 10.2 $57,857 - $74,062 25,949 8.87 10.9 $74,063+ 28,283 9.20 12.8 Insurance Medicaid 11,677 9.49 13.2 <0.001 Medicare 79,039 7.89 9.3 Not Insured 3,083 7.16 10.4 Other Government 2,730 9.56 11.5 Private 26,732 11.20 15.6