The emergence of chimeric antigen receptor (CAR) T-cell therapy has changed the treatment landscape for diffuse large B-cell lymphoma (DLBCL), however, real-world evidence reporting outcomes among older patients treated with CAR T-cell therapy is limited. We leveraged the 100% Medicare Fee-for-Service claims database and analyzed outcomes and cost associated with CAR T-cell therapy in 551 older patients (age ≥65) with DLBCL who received CAR T-cell therapy between 2018 and 2020. CAR T-cell therapy was used in third line and beyond in 19% of patients age 65-69, 22% among those age 70-74, compared to 13% of patients age ≥75. The majority of patients received CAR T-cell therapy in an inpatient setting (83%), with an average length of stay of 21 days. The median event-free survival (EFS) following CAR T-cell therapy was 7.2 months. Patients age ≥75 had significantly shorter EFS compared to patients age 65-69 and age 70-74 with 12-month EFS estimates of 34%, 43% and 52%, respectively (p = 0.002). The median overall survival was 17.1 months and there was no significant difference by age groups. The median total healthcare cost during the 90-day follow-up was $352,572 and was similar across all age groups. CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was very low especially in patients age ≥75 and this age group had a lower rate of EFS which illustrates the unmet need for more accessible, effective, and tolerable therapy in older patients, especially in patients age ≥75.
Background
Although incidence and mortality of lung cancer have been decreasing, health disparities persist among historically marginalized Black, Hispanic, and Asian populations. A targeted literature review was performed to collate the evidence of health disparities among these historically marginalized patients with lung cancer in the U.S.
Methods
Articles eligible for review included 1) indexed in PubMed®, 2) English language, 3) U.S. patients only, 4) real-world evidence studies, and 5) publications between January 1, 2018, and November 8, 2021.
Results
Of 94 articles meeting selection criteria, 49 publications were selected, encompassing patient data predominantly between 2004 and 2016. Black patients were shown to develop lung cancer at an earlier age and were more likely to present with advanced-stage disease compared to White patients. Black patients were less likely to be eligible for/receive lung cancer screening, genetic testing for mutations, high-cost and systemic treatments, and surgical intervention compared to White patients. Disparities were also detected in survival, where Hispanic and Asian patients had lower mortality risks compared to White patients. Literature on survival outcomes between Black and White patients was inconclusive. Disparities related to sex, rurality, social support, socioeconomic status, education level, and insurance type were observed.
Conclusions
Health disparities within the lung cancer population begin with initial screening and continue through survival outcomes, with reports persisting well into the latter portion of the past decade. These findings should serve as a call to action, raising awareness of persistent and ongoing inequities, particularly for marginalized populations.
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