Study Analyzes Mortality Differences Between Black and White Patients with Stage III NSCLC

Lung cancer affects an estimated 235,000 adults in the United States each year and is the second most common cancer.¹ Black men are 15% more likely than white men to develop lung cancer, while the incidence in black women is 14% lower than in white women.¹ People aged >65 years are more likely to develop lung cancer, and it is a leading cause of cancer death for both men and women.¹ However, since the mid-2000s the incident rates of lung cancer have dropped approximately 2% each year.¹ Non–small-cell lung cancer (NSCLC) is the most common type of lung cancer and accounts for 84% of all lung cancer diagnoses.¹ The 5-year overall survival (OS) rate for people with NSCLC is 25%; for those with localized NSCLC, the 5-year survival rate is 63%. For regional NSCLC, the 5-year survival rate is 35% and with metastatic lung cancer the 5-year survival rate is 7%.¹

Approximately 30% of patients with NSCLC will have unresectable stage III cancer at diagnosis, with a 5-year survival rate of 29.7%.² Over the past 40 years, treatment for unresectable stage III NSCLC has progressed from radiation therapy only to platinum-based chemoradiation therapy followed by targeted immunotherapy.² Concurrent chemotherapy (CT) plus radiotherapy (RT) within 30 days of CT (CCRT) confers a survival benefit for patients with stage III NSCLC.³

At the June 2021 American Society of Clinical Oncology annual meeting, the results of a comparative analysis of mortality between black and white stage III NSCLC patients in the United States were presented.³ Black (N = 22,459) and white (N = 138,477) patients with NSCLC diagnosed between 2004 and 2015 were included in the study. Patients who received surgery and those with multiple tumors were excluded from the study. There were 6 groups of patients analyzed: CCRT (0-30 days between CT and RT); sequential chemotherapy plus radiotherapy (SCRT;21-120 days between CT and RT); RT (patient only received radiation therapy); CT (patient only received CT); no RT or CT (the patient did not receive RT or CT); and other (uncategorized treatment). Black patients received the following: 42.3% CCRT, 7.6% SCRT, 13.8% RT, 15.1% CT, and 21.2% no RT or CT. White patients received the following: 43.9% CCRT, 7.0% SCRT, 12.7% RT, 14.9% CT, and 21.5% no RT or CT.

Positive predictive factors for receiving CCRT were male gender and white race. In black patients, a decreased OS was associated with SCRT, RT only, CT only, and no RT or CT compared with CCRT. Median OS with CCRT was 18 months for black patients. In white patients, a decreased OS was associated with RT only, CT only, and no RT or CT, while SCRT did not decrease OS when compared with CCRT. Median OS with CCRT was 16 months for white patients. CCRT in stage III NSCLC gave an increased OS for both black and white patients.

References

1. Cancer.Net. Lung Cancer-Non-Small Cell: Statistics. American Society of Clinical Oncology. www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics. Accessed June 1, 2021.
2. Hansen RN, Zhang Y, Seal B, et al. Long-term survival trends in patients with unresectable stage III non-small cell lung cancer receiving chemotherapy and radiation therapy: a SEER cancer registry analysis. BMC Cancer. 2020;20:276.
3. Elimimian E, Arteta-Bulos R, Liang H, Bilani N, et al. A comparative analysis of mortality between black and white stage III non–small cell lung cancer patients in the United States. J Clin Oncol. 2021 (suppl_15):abstr 8552.