Disparities in utilization of novel cancer therapies in advanced stage III and IV melanoma and variance in outcomes

Significant gains in advanced melanoma have been made through immunotherapy trials. Factors influencing equitable access and survival impact of these novel therapies are not well-defined. Retrospective analysis using National Cancer Database of patients with advanced stage III and IV melanoma from 2004 to 2021. Multivariable logistic regression was used to study the use of immunotherapy and Cox proportional hazard regression to evaluate overall survival (OS). 47,427 patients with increasing utilization of immunotherapy from 13.78% in 2004 to 65.88% by 2021. Inequitable adoption were impacted by age, sex, socioeconomic status/affordability, insurance types and residential educational/income level. Receiving immunotherapy was associated with a 44% improvement in OS (HR 0.56, 95% CI 0.54–0.57) and receiving a clinical trial-based therapy was associated with a 37% improvement (HR 0.63, 95% CI 0.53–0.75). Among patients who received immunotherapy or clinical trial-base therapy, there was 40% worse survival in non-Hispanic Black patients (HR 1.40, 95% CI 1.16–1.69) compared to non-Hispanic Whites. There are disparities in utilization of immunotherapy that is influenced by socioeconomic status. Race and ethnicity had a significant influence in differential impact on survival outcomes of immunotherapies highlighting the importance of increasing underrepresented population participation in trials that lead to novel therapies. Between the mid-to-late 2000s and 2010s, multiple practice-changing clinical trials evaluated the benefit of immunotherapy in significantly reducing lethality of melanoma among individuals with advanced melanoma. It is unclear if the benefit of immunotherapy were seen across different patient groups in U.S. as studies have continued to demonstrate persistent disparities in outcomes within the realm of melanoma. We explored potential disparities in uptake of immunotherapies and differential impact of immunotherapies on outcomes across all groups of patients with advanced melanoma given that most of the clinical trials have not involved racial/ethnic minorities. In an analysis of a national cancer database, we observed a significant increase in the utilization of immunotherapy from 13.78% in 2004 to 65.88% in 2021, but unequal adoption of immunotherapy impacted by age and affordability/socioeconomic status. Patients receiving immunotherapy had a 44% improvement in overall survival, while those on clinical trial-based therapy had a 37% survival improvement. We observed that race/ethnicity was an important factor in intra-population variance of survival among those who received immunotherapy and/or clinical trials-based therapy highlighting the importance of increasing underrepresented population participation in trials that lead to novel immunotherapy development in order to better understand the impact of novel therapies across race/ethnic groups.