Socioeconomic focus in neoadjuvant chemoimmunotherapy: An analysis of pathologic complete response and overall survival in clinical stage II-III NSCLC patients.

8039 Background: In 2022, CheckMate 816 supported neoadjuvant chemoimmunotherapy (CTIO) as standard treatment for clinical stage II-III non-small cell lung cancer (NSCLC). Low socioeconomic status has historically been underrepresented in clinical trials, warranting further analysis of CTIO outcomes in patients from diverse socioeconomic backgrounds. This study aims to assess the role of socioeconomic factors on pathologic complete response (pCR) and overall survival (OS) after CTIO. Methods: Data from the National Cancer Database (NCDB) was obtained for patients diagnosed with clinical stage II-III NSCLC between 2022-2023 undergoing CTIO. Complete T, N, and M stage and post-pathologic status (ypT, ypN) were obtained. OS was available for patients diagnosed in 2022. Patients receiving neoadjuvant radiotherapy or with clinical or pathologic metastatic disease were excluded. Group comparisons were based on socioeconomic factors: age (< 75 vs ≥ 75 years), sex, race (Non-Hispanic White vs Other), primary payor at diagnosis, urban/rural, percent no high-school degree quartile, and median income quartile. Primary outcomes were pCR and OS, analyzed via logistic and cox regression models, respectively. All tests were two-sided, and a p-value of < 0. 05 was statistically significant. Results: 2, 819 patients received CTIO from 2022-2023, with 1, 134 patients diagnosed in 2022. Univariate analysis showed patients in the two lowest median income quartiles (46, 277–57, 856: OR 1. 40, 95% CI 1. 08-1. 80, p = 0. 011; < 46, 277: OR 1. 70, 95% CI 1. 30-2. 23, p < 0. 001) had significantly higher odds of pCR compared with those in the highest income quartile (≥74, 063). This effect persisted in multivariate analysis (46, 277–57, 856: OR 1. 59, 95% CI 1. 19-2. 13, p = 0. 002; < 46, 277: OR 2. 00, 95% CI 1. 41-2. 83, p < 0. 001). Univariate analysis showed that other race (HR 0. 49, 95% CI 0. 29-0. 81, p = 0. 006) was associated with improved OS compared to Non-Hispanic White, which persisted in multivariate cox analysis (HR 0. 50, 95% CI 0. 30-0. 85, p = 0. 010). There were no significant associations for pCR and OS with age, sex, primary payor at diagnosis, urban/rural status, or percent no high school degree quartile. Conclusions: Our findings present promising evidence of improved outcomes of neoadjuvant chemoimmunotherapy among groups facing historical marginalization, namely low-income communities and non-white race. These effects were persistent in multivariate regression models controlling for other socioeconomic variables such as age, sex, primary payor, urban/rural, and percent no high school degree quartile. In light of these findings, further studies with diverse patient populations are warranted to examine the benefit of neoadjuvant chemoimmunotherapy on patients with NSCLC.