Real-world disparities in survival among stage III-IV melanoma patients in the era of immunotherapy.

Abstract

e13767 Background: The CheckMate 067 and KEYNOTE-006 trials transformed melanoma care, improving survival outcomes. However, disparities in survival persist in the immunotherapy era (ITE). This study evaluates survival disparities among Stage III-IV melanoma patients in the ITE, using the pre-immunotherapy era (PITE) as historical control. Methods: Patients diagnosed with Stage III-IV melanoma (2006–2021) were identified from the National Cancer Database. The cohort was stratified into PITE (2006–2011) and ITE (2015–2020). Kaplan-Meier survival analysis and log-rank tests compared overall survival (OS) across eras. Multivariable Cox proportional hazards (Cox-PH) model was used to calculate hazard ratios (HRs) for death, due to race/ethnicity, income, insurance type, facility type, sex, disease stage, rural/urban status, and high school incompletion rates based on ITE. Results: A total of 77,495 patients (28,712 PITE; 48,783 ITE) were included. Median OS improved from 35.8 months in the PITE to 77.9 months in the ITE (p < 0.001). Within the ITE, disparities were evident. Non-Hispanic (NH) Black patients had a 26% higher hazard of death compared to NH White patients (HR = 1.26). Medicaid beneficiaries experienced a 38% higher hazard of death compared to privately insured patients (HR = 0.62). Patients earning < $46,277 had a 20% higher hazard of death than those earning > $74,063 (HR = 0.80). Those from areas with ≥15.3% high school non-completion had a 38% higher hazard of death compared to areas with < 5% non-completion (HR = 1.38). Academic facilities were associated with an 18% lower hazard of death compared to non-academic centers (HR = 0.82). Conclusions: While immunotherapy has significantly improved OS for Stage III-IV melanoma patients, disparities persist in the ITE. NH Black patients, Medicaid beneficiaries, those with lower incomes, low education levels, or treated at non-academic facilities face worse outcomes. Expanding access to immunotherapy and improving care at under-resourced centers is critical to reducing disparities. Survival outcomes and disparities within the immunotherapy era. Category Group Median OS (months) HR (95% CI) p-value Stage III >96 Ref — IV 10.8 (10.5–11.1) 3.41 (3.31–3.53) <0.001 Treatment Immunotherapy >96 0.61 (0.59–0.63) <0.001 No Immunotherapy 59.4 (56.8–61.8) Ref — Race/Ethnicity NH White 79.5 (77.3–81.6) Ref — NH Black 29.6 (25.7–39.1) 1.26 (1.08–1.48) <0.001 Hispanic 77.6 (59.2–91.0) 1.23 (1.01–1.49) 0.006 NH Asian/PI 61.5 (48.1–NA) 0.96 (0.88–1.06) 0.45 Insurance Private Insurance >96 0.62 (0.58–0.67) <0.001 Medicaid 56.3 (50.2–65.5) Ref — Income > $74,063 97.3 (92.0–103.2) 0.80 (0.75–0.85) <0.001 < $46,277 59.0 (54.0–64.2) Ref — Education <5% No Completion 98.0 (92.8–NR) Ref — ≥15.3% No Completion 63.7 (59.4–68.5) 1.38 (1.25–1.52) <0.001 Facility Type Academic 90.5 (87.2–94.5) 0.82 (0.80–0.85) <0.001 Non-Academic 53.4 (50.9–55.3) Ref —