Immunotherapy in stage IV non-small cell lung cancer according to racial characteristics and community of residence.

e20621 Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality worldwide. The advent of immunotherapy has transformed treatment paradigms for NSCLC. However, the use and effectiveness and immunotherapy may differ across racial groups and other sociodemographic factors, including sex, comorbidities, and community of residence. Our study analyzed disparities in immunotherapy receipt and overall survival among patients with stage IV NSCLC. Methods: Patients diagnosed with stage IV NSCLC from 2014 through 2016 were identified using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked dataset. Immunotherapy receipt was compared across racial groups: non-Hispanic Whites, Blacks, Asians, Hispanics, and Native Americans. A multivariable logistic regression model evaluated associations between immunotherapy receipt and demographic and clinical variables including age, sex, marital status, Charlson comorbidity index, and histology. A multivariable Cox proportional hazards model assessed associations between these variables and overall survival. Results: Among 21,444 patients, the majority (78.6%) were White, while 10.7% were Black, 4.9% were Asian, 1.6% were Hispanic, and 0.2% were Native American. The efficacy of immunotherapy treatment was present across races, associating with better overall survival versus no immunotherapy (adjusted HR: 0.54, 95% CI: 0.49-0.59). After accounting for community of residence, race remained a significant factor in immunotherapy receipt (type 3 p-value: 0.028). Further adjustment for other covariates revealed that Black patients had significantly lower odds of receiving immunotherapy than White patients (adjusted OR: 0.64, 95% CI: 0.47-0.87). While Hispanics and Asians also had lower rates of receiving immunotherapy, these differences were not statistically significant. Asian patients exhibited higher overall survival compared to other races (adjusted HR: 0.88, 95% CI: 0.82-0.95). Conclusions: Use of immunotherapy for stage IV NSCLC is substantially lower among Blacks and other minority groups compared to Whites, indicating racial disparities in access to novel lung cancer treatments. Patients treated in urban areas are more likely to receive immunotherapy, underscoring the need to expand consistent access to efficacious treatments for advanced NSCLC. Ensuring equal access to effective treatments such as immunotherapy, regardless of race or community of residence, has the potential to improve outcomes and reduce racial disparities in lung cancer survival.