Abstract A107: Area deprivation index and immunotherapy outcomes in patients with metastatic solid tumors

Abstract Background: Neighborhood socioeconomic deprivation, as measured by the Area Deprivation Index (ADI), is associated with poor outcomes for patients (pts) receiving chemotherapy. Immune checkpoint inhibitors (ICI) have changed the landscape of many solid tumors, but data is limited regarding the association of ADI and outcomes with ICI treatment. Our group recently linked higher ADI to worse survival outcomes for pts with metastatic renal cell carcinoma receiving ICI, but the applicability of this finding to other solid tumors is unknown. We investigated associations between ADI and survival outcomes with ICI treatment in an expanded solid tumor cohort. Methods: This IRB-approved retrospective cohort included adults with metastatic solid tumors treated with ICI at Johns Hopkins (2013 – 2024). Eligible pts received ≥4 weeks of ICI (in any line) and had a response assessment. Pts receiving adjuvant ICI were excluded. Demographic and clinical data were abstracted from records, with follow up through December 1 2024. ADI at ICI start was obtained from the Neighborhood Atlas and categorized into quartiles (1st:1-25, 2nd: 26-50, 3rd: 51-75, 4th: 76-100), with higher scores indicating greater deprivation. Overall survival (OS) and progression free survival (PFS) were calculated from ICI start by the Kaplan Meier method. Univariate and multivariate analyses were used to model associations of ADI on OS and PFS, adjusting for age, sex, patient-reported race, and performance status. Results: 691 pts were included. The majority were male (67% n=462); median age was 65.2 years at ICI initiation. The majority reported white race (79% n=547). 6% (n=44) resided in the most deprived ADI quartile and 23% (n=159) were in the more deprived half. The most common malignancies were renal or bladder (44%), cutaneous (36%), and gastrointestinal/hepatic (13%). 70% received ICI in the 1st line. Patients residing in more deprived quartiles were more likely to report non-white race (Chi-square p-value <0.01) and have worse performance status (Chi-square p-value 0.01). Univariate analysis showed a trend toward shorter OS with increasing deprivation (HR 1.60 comparing most deprived to least deprived quartile), though this did not reach statistical significance (p=0.143). Multivariate analysis did not show a statistically significant association comparing most deprived ADI quartile to least deprived ADI quartile for OS (HR 1.38 [95% CI 0.90-2.11] p=0.15). There was no significant difference in association between ADI and PFS by univariate analysis (likelihood ratio p-value 0.215). Conclusions: In a cohort of pts with metastatic solid tumors receiving ICI, a trend toward shorter OS was observed for pts residing in more deprived areas at treatment initiation, but this association was not statistically significant. These results may be limited by sample size, follow-up duration, and heterogenous treatment effects among tumor types. An expanded study is planned with the goal of examining associations between ADI and outcomes among a larger population with longer follow up. Citation Format: Dena P. Rhinehart, Ardit Feinaj, Marianna Zahurak, Shuait Nair, Jona Mata, Evan J. Lipson, Mark Yarchoan, Govind Warrier, Yasser Ged. Area deprivation index and immunotherapy outcomes in patients with metastatic solid tumors [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A107.