Conference Abstracts - Summit on Cancer Health Disparities (SCHD25)
Vol. 5, Issue Supplement 1, 2025 · S1-2
Race-associated clinicogenomic correlates of outcomes to immune checkpoint inhibitors alone or with chemotherapy in non-small cell lung cancer (NSCLC)
Nirosha Perera, MD,Lingzhi Hong, MD PHD,Waree Rinsurongkawong , PHD,Elliana Young, MS,Jianjun Zhang, MD PHD,John Lin, MD MSHP
Submission received: 2025-02-14 / Accepted: 2025-03-06 / Published: 2025-04-24
Abstract
Background
PD-L1 low and STK11 mutations are associated with immune checkpoint inhibitor (ICI) resistance in non-small cell lung cancer (NSCLC). It is unclear whether there are differences in clinicogenomic predictors by race and ethnicity.
Methods
We retrospectively studied NSCLC patients 18 or older, without targetable EGFR or ALK alterations, treated with frontline combination chemotherapy with ICI (ICI-chemo) or ICI monotherapy (ICI-mono) between January 2014 and February 2020 at MD Anderson Cancer Center. We analyzed clinicogenomic and survival characteristics by race/ethnicity. Differences in clinicogenomic predictors were assessed through log-rank and chi-squared comparison of proportions tests. Survival differences were estimated via the Kaplan-Meier method.
Results
1648 patients met the inclusion criteria. Prevalence of poor performance status (PS) frequency was statistically significantly different among groups, highest in African American (AA) (30.7%) and Native Alaskan/Hawaiian or American Indian (NAHAI) (30%) patients (Table). Steroid prescription within one month of ICI start was also more frequent in AA (46.4%) and NAHAI (40%) patients. However, heavy smoking was more frequent in White (62%) patients. Mutation rates were statistically significantly different for KRAS and STK11 but not TP53 (Table). KRAS mutations were most frequent in White (24.7%) and AA patients (24.2%). STK11 mutations were most frequent in AA (14.4%) patients. TP53 mutations were most frequent in HL and Black (43.6%, 41.8%) patients. Median overall survival (OS) was lower (21.3 and 24.5 months) for HL and NAHAI patients and higher (25.4, 26.4, and 30.7 months) for White, Black, and Asian patients, though not statistically significantly different (Table).
Conclusion
AA and HL patients had lower rates of heavy smoking but higher rates of poor genomic prognostic factors. Asian patients had the lowest rates of heavy smoking, the lowest rates of KRAS, TP53, and STK11 mutations, but the highest rates of PD-L1≥1%. Despite several traditional clinicogenomic prognostic factors being poor for minority racial/ethnic groups, the OS difference was not statistically significant.