NSCLC in the immunotherapy era: Trends in survival and disparities across demographic and socioeconomic groups.

Abstract

e20565 Background: Advanced non-small cell lung cancer (NSCLC) has historically been associated with poor survival outcomes. The introduction of immune checkpoint inhibitors in 2015 revolutionized treatment by improving survival, yet access to these therapies remains inequitable. This study examines survival trends in NSCLC before and after 2015, focusing on racial and socioeconomic disparities in the immunotherapy era. Methods: This population-based study utilized SEER registry 22 to evaluate survival disparities in NSCLC cases diagnosed between 2004 and 2020. Patients were stratified by stage (regional and distant), age, race, income, and sex. Survival outcomes, including median survival (MS) and five-year overall survival (5-Year OS), were compared using Kaplan-Meier analysis and log-rank tests to assess disparities across demographic and socioeconomic subgroups. Results: Among 591,525 NSCLC cases were included, with 355,283 diagnosed pre-2015 and 236,242 post-2015. MS improved from 11 months pre-2015 to 13 months post-2015 (p < 0.001). Five-year overall survival increased from 16.8% pre-2015 to 19.6% post-2015, reflecting advancements in care over time. Racial disparities persisted across both periods. Non-Hispanic Black patients had the lowest survival rates, with five-year overall survival improving from 21.4% pre-2015 to 24.5% post-2015 in localized stages, compared to 25.7% and 29.2% for Non-Hispanic White patients. Among patients with distant-stage disease, survival improved marginally from 6.7% pre-2015 to 7.9% post-2015 for non-Hispanic Black patients, lagging behind non-Hispanic White patients, whose survival increased from 8.6% to 10.3%.Socioeconomic disparities were also evident. Patients earning less than $50,000 experienced a five-year overall survival increase from 28.2% pre-2015 to 30.4% post-2015 in regional stages, compared to 35.4% to 38.9% for those earning above $100,000. However, in distant stages, survival gains for low-income patients were less pronounced, rising only from 4.5% pre-2015 to 5.2% post-2015, compared to 7.8% to 9.3% for higher-income patients. Younger patients (<35 years) had consistently better outcomes across all stages and periods, with a five-year overall survival of 40.3% pre-2015 and 43.7% post-2015 in distant stages. Conversely, patients aged 50–64 years experienced the lowest survival gains, emphasizing the need for targeted interventions in this group. These findings underscore persistent disparities in NSCLC survival by race and income, despite overall improvements in outcomes over time. Conclusions: While survival improved modestly for NSCLC patients post-2015, significant disparities persist based on stage, race, income, and age. Non-Hispanic Black patients and lower-income individuals face the greatest challenges, underscoring the need for targeted interventions to address these inequities.