The impact of the Area Deprivation Index on immunotherapy outcomes in metastatic renal cell carcinoma (mRCC).

Abstract

445 Background: The treatment landscape of mRCC has evolved in recent years with the advent of immune-checkpoint inhibitors (ICIs). The Area Deprivation Index (ADI) measures social determinants of health geographically, ranking neighborhoods by socioeconomic disadvantage. However, there are limited data on ICIs outcomes in relation to ADI. We investigated the association between ADI and clinical outcomes of ICI in mRCC. Methods: We conducted a retrospective analysis of 560 mRCC patients (pts) treated at our institution from 2013 to 2024. Eligibility included metastatic disease and ICI treatment at any line. Baseline characteristics and treatment outcomes were obtained from chart review. The ADI scores were calculated by entering the pts addresses at the time of starting ICI into the Neighborhood Atlas. The results were categorized into four quartiles (1st:1-25, 2nd: 26-50, 3rd: 51-75, 4th: 76-100), with higher scores indicating greater deprivation. Overall survival (OS) and progression-free survival (PFS) were calculated from the start of ICI by the Kaplan-Meier method. Immune-related toxicity was assessed across ADI groups. Univariate and multivariate analyses were performed to assess the impact of ADI on survival outcomes, controlling for confounding variables. Results: Our analysis included 287 eligible mRCC pts. Most pts were male (n=208, 72%) with a median age at ICI start of 63 years. Primary histology was clear cell in 238 pts (83%). Pts were 79% White, 13% Black, and 7% other races. Most pts received ICI in the first line (65%) and in combinations (71%). Based on ADI quartiles, 46.3% were in the 1st, 32.4% in the 2nd, 15.3% in the 3rd, and 6% in the 4th quartile. Survival analyses revealed that pts in the highest ADI quartile (4th) had significantly shorter OS (p=0.01) and PFS (p=0.03) compared to those from areas with lower ADI scores. Multivariate analysis confirmed shorter OS in the highest ADI quartile (HR 2.39 [1.32, 4.31], p=0.004). No significant differences in immune-related toxicity rates were observed. Univariate analysis of the continuous ADI values revealed a correlation of higher scores with shorter OS (HR 1.24 [95% CI: 1.06-1.46] p=0.008) and PFS (HR 1.17 [95% CI: 1.02-1.35] p=0.03). Conclusions: Despite landmark improvements in survival outcomes with ICIs in mRCC, pts in deprived areas continue to experience poorer outcomes, highlighting the need for targeted interventions to enhance access to care and to better understand how neighborhood deprivation impacts overall health both prior to diagnosis and over the course of care. Further pan-cancer studies are essential to validate these findings.