Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States

Ahn, Joseph; Lauzon, Marie; Luu, Michael; Noureddin, Mazen; Ayoub, Walid; Kuo, Alexander; Sundaram, Vinay; Kosari, Kambiz; Nissen, Nicholas N.; Gong, Jun; Hendifar, Andrew Eugene; Roberts, Lewis R.; Abou‐Alfa, Ghassan K.; Singal, Amit G.; Yang, Ju Dong

doi:10.1002/hep.32527

Cited by 22 publications

(20 citation statements)

References 46 publications

(58 reference statements)

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“…This is consistent with prior studies that showed underrepresentation of racial/ethnic minorities in clinical trials (29,30). Prior nationwide studies showed a lower likelihood of accessing TARE (16) and immunotherapy (31) in non-White racial/ethnic groups. Socioeconomic inequalities, mistrust in doctors, and implicit bias of the providers hinder access to advanced cancer therapy (32–34).…”

Section: Discussionmentioning

confidence: 96%

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma

et al. 2023

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(249/250 words) Background: The efficacy and safety of combined immunotherapy and transarterial radioembolization (TARE) were suggested in pre-clinical and early-phase trials, but these were limited by small sample sizes. We sought to compare the efficacy of combined therapy and immunotherapy alone in patients with advanced hepatocellular carcinoma (HCC). Methods: The National Cancer Database was used to identify patients with advanced HCC diagnosed between 1/1/2017 and 12/31/2019. We included patients who received combined therapy or immunotherapy alone as first-line treatment. Multivariable logistic regression was conducted to determine predictors of combined therapy. Kaplan-Meier and Cox regression approaches were used to identify predictors of overall survival and to compare hazards of mortality between the patients who received combined therapy and immunotherapy alone. Results: Of 1,664 eligible patients with advanced-stage HCC, 142 received combined TARE/immunotherapy and 1522 received immunotherapy alone. Receipt of combination therapy was associated with care at an academic center and inversely associated with racial/ethnic minority status (Hispanics and Blacks). Median overall survival was significantly higher in the combination group than in the immunotherapy alone group (19.8 vs. 9.5 months). In multivariable analysis, combined therapy was independently associated with reduced mortality (adjusted HR 0.50, 95%CI: 0.36-0.68, p<0.001). Results were consistent across subgroups and in sensitivity analyses using propensity score matching and inverse probability of treatment weighting. Conclusion: The combination of TARE and immunotherapy was associated with improved survival compared to immunotherapy alone in patients with advanced stage HCC. Our findings underly the importance of large clinical trials evaluating combination therapy in these patients.

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Section: Discussionmentioning

confidence: 96%

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma

et al. 2023

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“…This is an important albeit unsurprising finding, as it mirrors the known disparate access to care in HNC. While previous studies have found racial and ethnic disparities in access to immunotherapy in other cancer sites, our study makes a novel contribution by describing a potential disparity specific to HNC using clinical data. Of all cancers, HNC has the third-worst survival disparity between Black and White patients, and the disparate receipt of immunotherapy reported in this study illustrates how new therapeutics, while potentially effective, may inadvertently exacerbate already existing survival disparity .…”

Section: Discussionmentioning

confidence: 99%

Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer

Ramkumar,

Bhardwaj,

Patel

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe US Food and Drug Administration approved immune checkpoint inhibitors (immunotherapy) for select cases of head and neck squamous cell carcinoma (HNSCC) in 2016. However, it is unclear whether there are clinical or sociodemographic differences among patients receiving immunotherapy as part of their care. Given the known disparities in head and neck cancer care, we hypothesized that there are differences in receipt of immunotherapy among patients with HNSCC based on clinical and nonclinical characteristics.ObjectiveTo characterize clinical and nonclinical factors associated with receipt of immunotherapy among older patients with HNSCC.Design, Setting, and ParticipantsThis retrospective cohort study included patients 65 years or older diagnosed with HNSCC (n = 4860) in a community oncology care setting. Electronic health records from Navigating Cancer were assessed from January 1, 2017, to April 30, 2022.Main Outcomes and MeasuresMultivariable logistic regression was used to characterize clinical (tumor stage [localized vs advanced] and anatomical subsite [oropharyngeal vs nonoropharyngeal]) and nonclinical (age, smoking history, race and ethnicity, sex, and marital status) factors associated with receipt of immunotherapy.ResultsIn the study cohort of 4860 patients, 3593 (73.9%) were men; 4230 (87.0%) were White and 630 (13.0%) were of other races. A total of 552 patients (11.4%) had received immunotherapy. After adjusting for covariates, in the final model, White patients with HNSCC had 80% increased odds of receiving immunotherapy (adjusted odds ratio [AOR], 1.80 [95% CI, 1.30-2.48]) compared with patients of other races. There were no statistically significant differences in the odds of receiving immunotherapy based on age, sex, or smoking history. Patients with nonoropharyngeal disease were significantly more likely to receive immunotherapy than those with oropharyngeal cancer (AOR, 1.29 [95% CI, 1.05-1.59]), as were those with advanced compared with local disease (AOR, 2.39 [95% CI, 1.71-3.34]).Conclusions and RelevanceThe findings of this cohort study suggest that among older patients with HNSCC, White patients may be more likely to receive immunotherapy as part of their care. Equitable access to immunotherapy and other treatment options will reduce cancer-related health disparities and improve survival of patients with HNSCC.

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“…Early accessibility to immunotherapy is characterized by major differences among Hispanics and Blacks as compared to Whites. 90 PDL1 expression and tumor genomic profiles in breast, lung, and colorectal cancers have not been shown to differ in different ethnic groups, although there are notable variations in the immune cell population in the tumor microenvironment. 91 For example, compared to non-Hispanic white patients, breast tumors from black patients had a compelling immune cell prevalence and enhanced expression of inhibitory receptors like PD1, CTLA4, and LAG3.…”

Section: Disparities In Targeted Treatments and Immunotherapymentioning

confidence: 99%

“…In metastatic HCC, immunotherapy is preferred over chemotherapy for survival in general. Early accessibility to immunotherapy is characterized by major differences among Hispanics and Blacks as compared to Whites 90 …”

Section: Disparities In Targeted Treatments and Immunotherapymentioning

confidence: 99%

Racial disparities in cancer care, an eyeopener for developing better global cancer management strategies

Bharmjeet

Das

2023

Cancer Reports

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BackgroundIn the last few decades, advancements in cancer research, both in the field of cancer diagnostics as well as treatment of the disease have been extensive and multidimensional. Increased availability of health care resources and growing awareness has resulted in the reduction of consumption of carcinogens such as tobacco; adopting various prophylactic measures; cancer testing on regular basis and improved targeted therapies have greatly reduced cancer mortality among populations, globally. However, this notable reduction in cancer mortality is discriminate and reflective of disparities between various ethnic populations and economic classes. Several factors contribute to this systemic inequity, at the level of diagnosis, cancer prognosis, therapeutics, and even point‐of‐care facilities.Recent FindingsIn this review, we have highlighted cancer health disparities among different populations around the globe. It encompasses social determinants such as status in society, poverty, education, diagnostic approaches including biomarkers and molecular testing, treatment as well as palliative care. Cancer treatment is an active area of constant progress and newer targeted treatments like immunotherapy, personalized treatment, and combinatorial therapies are emerging but these also show biases in their implementation in various sections of society. The involvement of populations in clinical trials and trial management is also a hotbed for racial discrimination. The immense progress in cancer management and its worldwide application needs a careful evaluation by identifying the biases in racial discrimination in healthcare facilities.ConclusionOur review gives a comprehensive evaluation of this global racial discrimination in cancer care and would be helpful in designing better strategies for cancer management and decreasing mortality.

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Racial and ethnic disparities in early treatment with immunotherapy for advanced HCC in the United States

Cited by 22 publications

References 46 publications

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma

Differences in Receipt of Immunotherapy Treatment Among Patients With Head and Neck Cancer

Racial disparities in cancer care, an eyeopener for developing better global cancer management strategies

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