Abstract 3625: Urban-rural and racial disparities in the utilization of immune checkpoint inhibitor (ICI) treatments for non-small cell lung cancer (NSCLC)

Abstract Background: While ICIs have revolutionized NSCLC management, studies regarding real-world ICI uptake are limited. Before ICIs became the standard of care, NSCLC research uncovered inequities in treatment outcomes by race and other social determinants, like rurality. It is unclear if similar disparities exist for ICI treatment. This population-based study aims to investigate differences in ICI treatment uptake by race and rurality among late-stage NSCLC patients. Methods: Patients ≥ 66 years diagnosed with stage III or IV NSCLC, with continuous Medicare coverage ≥ 12 months prior to diagnosis, were identified using the SEER-Medicare database. ICI treatment uptake was analyzed between January 1, 2014 and December 31, 2019. A multivariable logistic regression model was used to assess the likelihood of receiving ICI treatment, adjusting for age, year of diagnosis, sex, race, rurality, Charleson comorbidity index, cancer histology, dual eligibility for Medicaid, and state buy-in to Medicaid. Race was self-reported. Rurality was identified using SEER’s Rural-Urban Continuum Codes 04-09. Results: Of the 18, 083 patients identified with NSCLC, 1, 316 (7.38%) were Black and 15, 972 (88.34%) were White; 3, 230 (17.86%) lived in rural areas and 14, 853 (82.14%) in urban areas. ICI treatment uptake increased from 8.70% of patients diagnosed in 2014 to 31.35% in 2017. ICI treatment rates were 15% lower in Black patients compared to White patients, and 25% lower for rural residents compared to urban residents (Table 1). No significant difference was found comparing patients of other races to White patients. (Table 1). Conclusion: This population-based study documented increasing ICI usage over time, with significant rural-urban and racial disparities in treatment. These findings highlight the need to implement initiatives addressing rural and racial differences in both accessing ICI treatment for NSCLC and improving overall treatment equity. Citation Format: Mary T. Davis, Nikita Nikita, Krupa Gandhi, Scott W. Keith, Sarah Gordon, Rebecca Hartman, Swapnil Sharma, Amy Shaver, Grace Lu-Yao. Urban-rural and racial disparities in the utilization of immune checkpoint inhibitor (ICI) treatments for non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3625.