Race, Poverty, and Initial Implementation of Precision Medicine for Lung Cancer

Kehl, Kenneth L.; Lathan, Christopher S.; Johnson, Bruce E.; Schrag, Deborah

doi:10.1093/jnci/djy202

Cited by 46 publications

(49 citation statements)

References 13 publications

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“…Older adults in our study were likely to have underlying health problems other than NSCLC, including multiple comorbid conditions, prior autoimmune disease, or a proxy of poor performance status. The percentage of patients receiving care at NCI‐designated cancer centers was higher than the previously reported rate of NCI‐designated cancer center attendance in patients with advanced lung cancer, and it is likely to reflect the earlier adoption of treatment with immune checkpoint inhibitors in these centers.…”

Section: Discussionmentioning

confidence: 88%

Real‐world use and survival outcomes of immune checkpoint inhibitors in older adults with non–small cell lung cancer

Youn

Trikalinos

Mor

et al. 2020

Cancer

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Background Limited data exist regarding the characteristics and survival outcomes of older adults with non–small cell lung cancer (NSCLC) who receive immune checkpoint inhibitors in routine oncology practice. Methods Using the Surveillance, Epidemiology, and End Results–Medicare linked database, we identified 1256 patients aged ≥65 years who were diagnosed with pathologically confirmed stage I to stage IV NSCLC between 2002 and 2015 and initiated nivolumab or pembrolizumab in 2016. We examined patient characteristics and overall survival from the time of immune checkpoint inhibitor initiation through December 31, 2017. Results The median patient age at the time of immune checkpoint inhibitor initiatiton was 75.3 years (interquartile range, 8.5). A substantial percentage of patients were initially diagnosed with stage IV disease (42.6%) and had ≥2 comorbid conditions (48.7%). Using a claims‐based proxy, 11.5% of patients had poor performance status and 12.6% had a history of autoimmune conditions. The median overall survival after initiation of immune checkpoint inhibitor was 9.3 months (95% CI, 8.5‐10.5 months). The 1‐year survival rate was 43.0% (95% CI, 40.2‐45.7%). In multivariable analyses, multiple comorbid conditions, squamous histology, a history of nonplatinum doublet systemic therapy, recent radiotherapy, and a shorter time from initial diagnosis to treatment initiation were found to be statistically significantly associated with an increased hazard of death. Demographics, poor performance status, and prior autoimmune conditions were not significantly associated with the hazard of death. Conclusions Many older adults with NSCLC who initiated immune checkpoint inhibitors had multiple comorbidities, a history of autoimmune disease, or poor performance status. Factors associated with poor prognosis among patients with advanced NSCLC were also associated with worse survival in older adults treated with immune checkpoint inhibitors.

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Section: Discussionmentioning

confidence: 88%

Real‐world use and survival outcomes of immune checkpoint inhibitors in older adults with non–small cell lung cancer

Youn

Trikalinos

Mor

et al. 2020

Cancer

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“…In short, a propensity score represents the probability that a unit with certain characteristics will be assigned to the treatment group and helps to balance multiple characteristics in retrospective studies to approximate a random experiment. In our study, variables included in the model were age at diagnosis, gender, race, location of primary sites, chemotherapy, and radiotherapy status, which were likely to have an impact on survival for patients with lung cancer according to previous researches (14)(15)(16)(17)(18). For PSM between LCNEC and LADC, and between LCNEC and LSCC, 1:1 PSM without replacement was implemented, and nearest neighbor matching method with caliber of 0.001 was used.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for Surgery in Stage IA Large Cell Lung Neuroendocrine Compared With Other Types of Non-Small Cell Lung Cancer: A Propensity Score Matching Study Based on the Surveillance, Epidemiology, and End Results (SEER) Database

Zou

Guo

et al. 2020

Front. Oncol.

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BackgroundPulmonary large cell neuroendocrine cancer (LCNEC) is commonly classified as non-small cell lung cancer (NSCLC). Even for stage I disease, after surgery the survival is always poor, but clinical research on LCNEC is scant and always with unsatisfying sample sizes. Thus, we conduct the first study using the Surveillance, Epidemiology, and End Results (SEER) database to compare survival after surgery between stage I LCNEC and other types of NSCLC.MethodsFrom 2004 to 2016, 473 patients with stage IA LCNEC, 17,669 patients with lung adenocarcinoma (LADC) and 8,475 patients with lung squamous cell cancer (LSCC), all treated with surgery were identified. In addition, 1:1 PSM was used, and overall (OS) and cancer-specific survival (CSS) between groups were compared.ResultsThe 5-year OS rates and CSS rates for LCNEC were 52.5% and 81.5%, respectively. Overall, both OS and CSS were significantly superior for stage IA LADC than LCNEC (for OS: HR 0.636, 95% CI 0.568-0.712; for CSS: HR 0.688, 95% CI 0.561–0.842, LCNEC as reference), while comparable for LSCC with LCNEC (for OS: HR 0.974, 95% CI 0.869–1.091; for CSS: HR 0.907, 95% CI 0.738–1.115). PSM generated 471 pairs when LCNEC was compared with LADC and both OS and CSS were significantly better in LADC than LCNEC (for OS: HR 0.580, 95% CI 0.491–0.686; for CSS: HR 0.602, 95% CI 0.446–0.814). Of note, for the subgroup of patients ≤ 65 years old, HRs for both OS and CSS were lower (for OS: HR 0.470; for CSS: HR 0.482). As for comparison between LCNEC and LSCC, PSM generated 470 pairs. Differently, only CSS was significantly superior in LSCC than LCNEC (HR 0.563, 95% CI 0.392–0.807), while OS was not. Further grouping by age showed only CSS between two groups for patients with age ≤ 65 years old was significantly different (P = 0.006).ConclusionsWe report the first survival comparison after surgery between stage IA LCNEC and other types of NSCLC by SEER database and PSM. Our results demonstrated after surgery, stage IA LCNEC was worse in survival, especially compared to LADC. Extra clinical care should be paid, especially for younger patients. More studies investigating adjuvant therapy are warranted.

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“…242 Asians, women and never smokers were more likely to be tested, and AA/B, Hispanics/Latinos and patients on Medicaid were less likely to be tested. 242 , 243 …”

Section: Disparities In Lung Cancermentioning

confidence: 99%

Cancer health disparities in racial/ethnic minorities in the United States

et al. 2020

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There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

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Race, Poverty, and Initial Implementation of Precision Medicine for Lung Cancer

Cited by 46 publications

References 13 publications

Real‐world use and survival outcomes of immune checkpoint inhibitors in older adults with non–small cell lung cancer

Real‐world use and survival outcomes of immune checkpoint inhibitors in older adults with non–small cell lung cancer

Outcomes for Surgery in Stage IA Large Cell Lung Neuroendocrine Compared With Other Types of Non-Small Cell Lung Cancer: A Propensity Score Matching Study Based on the Surveillance, Epidemiology, and End Results (SEER) Database

Cancer health disparities in racial/ethnic minorities in the United States

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