Immunotherapy use for late-stage kidney, bladder cancers varies by race, socioeconomics
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Key takeaways:
- Black and Hispanic patients with stage IV clear cell renal cell carcinoma received immunotherapy less often than others.
- Immunotherapy receipt also varied by income, education and insurance status.
Immunotherapy utilization for treatment of advanced kidney or bladder cancers varied by patients’ race or socioeconomic status, according to study results.
Utilization also varied by type of health care facility.
“With the rapidly changing pace of innovation in cancer therapeutics, it is important that all patients have access to novel, potentially lifesaving medications,” researcher Solomon Woldu, MD, associate professor of urology and a member of Harold C. Simmons Comprehensive Cancer Center at UT Southwestern, said in a press release. “Our study highlights critical gaps in health care equity when it comes to treatments that have been shown effective in prolonging survival.”
Immunotherapy drugs are increasingly used for treatment of locally advanced or metastatic clear cell renal cell carcinoma (RCC) or urothelial carcinoma, according to study background.
Prior trials have demonstrated survival benefit with this approach, but certain barriers can prevent equitable access to such advanced therapies.
Woldu and colleagues assessed socioeconomic and demographic factors associated with immunotherapy receipt for clear cell RCC and urothelial carcinoma.
Researchers queried the National Cancer Database to identify patients diagnosed with stage IV clear cell RCC between 2015 to 2020 or stage IV urothelial carcinoma between 2017 and 2020.
Receipt of immunotherapy therapy using multivariate logistic regression served as the primary outcome.
Researchers identified 15,926 patients with stage IV clear cell RCC, of whom 5,419 (34%) received immunotherapy. They identified 10,380 patients with stage IV urothelial carcinoma, of whom 2,231 (21.5%) received immunotherapy.
Immunotherapy receipt for both groups increased over time.
For patients with clear cell RCC, Black (OR = 0.77; 95% CI, 0.64-0.93) and Hispanic (OR = 0.73; 95% CI, 0.61-0.86) individuals received immunotherapy less often than those of other races. Results showed no association between race and immunotherapy receipt in the urothelial carcinoma cohort.
Researchers determined patients treated at non-academic facilities, those with lower income and those with lower education levels less frequently received immunotherapy.
Utilization also varied by insurance status.
Individuals with private insurance or Medicare insurance received immunotherapy more often than those with no insurance; however, simply having health insurance did not necessarily ensure “affordable coverage for expensive and novel therapies,” researchers wrote.
“In the era of FDA-approved immunotherapy for advanced [clear cell] RCC and urothelial carcinoma, this national cohort analysis suggests that immunotherapy utilization is increasing over time, but significant disparities exist based on income, education, and insurance status in both malignancies,” Woldu and colleagues wrote. “Additionally, patients treated at nonacademic facilities were less likely to receive immunotherapy for the specific genitourinary malignancies. ... Identifying strategies to mitigate these differences and provide equitable access to immunotherapy is of imperative need.”
References:
- Holland L, et al. Urol Oncol. 2024;doi:10.1016/j.urolonc.2024.06.012.
- Widespread disparities exist in treating advanced cancers (press release). Available at: https://www.utsouthwestern.edu/newsroom/articles/year-2024/sept-widespread-disparities-advanced-cancers.html. Published Sept. 4, 2024. Accessed Oct. 17, 2024.
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