Persistent ethnicity-associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access.
Persistent ethnicity-associated disparity in anti-tumor effectiveness of immune checkpoint inhibitors despite equal access.
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DOI：
10.1158/2767-9764.crc-21-0143
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发表时间：
2022-07-26
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我们回顾了2015年至2020年间，在贝勒医学院（Houston， TX） Dan L. Duncan综合癌症中心的三个临床中心之一，对207例诊断为肺癌或头颈癌的化疗/ICI联合治疗和ICI单药治疗的患者对免疫检查点抑制剂（ICI）的反应。其中两个展馆（哈里斯卫生系统和迈克尔·e·德贝基退伍军人事务医疗中心）为大量少数民族人口提供服务，并提供平等的医疗服务。174例患者被诊断为肺癌（非小细胞或小细胞），33例被诊断为头颈部鳞状细胞癌（HNSCC）。38%的人认为自己是黑人，45%的人认为自己是非西班牙裔白人，18%的人认为自己是西班牙裔。客观缓解率（ORR）在肺癌（35.057%）和HNSCC （30.3%, P = 0.894）患者中相似。西班牙裔和黑人患者的ORR低于非西班牙裔白人患者（H 27.0%, B 32.5%, W 38.7%; H vs W P = 0.209; B vs W P = 0.398）。当仅考虑ICI单药治疗的患者时，西班牙裔患者的ORR进一步下降至20.7%，而黑人和非西班牙裔白人患者的ORR保持不变（B 29.3%, W 35.9%, H vs W P = 0.133; B vs W P = 0.419）。免疫相关不良事件在西班牙裔人群中最低，仅30%的患者发生，而黑人队列中为40%，非西班牙裔白人队列中为50%。据我们所知，本报告首次比较了ICI在不同患者群体中的有效性，其中大量黑人和西班牙裔非小细胞肺癌和非小细胞肺癌患者群体在平等获得护理的背景下接受治疗。本文提供的数据表明，ICI单药治疗在西班牙裔患者中的有效性降低，因此强调需要改善ICI临床试验中种族/少数民族患者的准入和代表性。
We reviewed response to immune checkpoint inhibitors (ICI) of 207 patients with diagnoses of lung or head and neck cancer treated with chemotherapy/ICI combination therapy and ICI monotherapy between 2015 and 2020 at one of three clinical pavilions associated with the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine (Houston, TX). Two of these pavilions (Harris Health System and the Michael E. DeBakey Veterans Affairs Medical Center) serve large minority populations and provide equal access to care regardless of means. 174 patients had a diagnosis of lung cancer (non–small cell or small cell) and 33 had a diagnosis of head and neck squamous cell carcinoma (HNSCC). 38% self-identified as Black, 45% as non-Hispanic White, and 18% as Hispanic. The objective response rate (ORR) was similar for patients with lung cancer (35.057%) and HNSCC (30.3%; P = 0.894). The ORR for Hispanic and Black patients was lower compared with non-Hispanic White patients (H 27.0%, B 32.5%, W 38.7%; H vs. W P = 0.209; B vs. W P = 0.398). When considering only patients treated with ICI monotherapy, the ORR for Hispanic patients dropped further to 20.7% while the ORR of Black and non-Hispanic White patients remained about the same (B 29.3% and W 35.9%, H vs. W P = 0.133; B vs. W P = 0.419). Immune-related adverse events were the lowest in the Hispanic population occurring in only 30% of patients compared with 40% of patients in the Black cohort and 50% of the non-Hispanic White cohorts. To our knowledge, this report is the first to compare ICI effectiveness within a diverse patient population with a substantial Black and Hispanic NSCLC and HNSCC patient population treated in the context of equal access to care. The data presented in this article suggests reduced effectiveness of ICI monotherapy in Hispanic patients and thereby underscores the need for improved access and representation of racial/ethnic minority patients in ICI clinical trials.