Survival differences in advanced non-small cell lung cancer after developments in regimens with immune check point inhibitors: Population based retrospective study from United States SEER database.

e20516 Background: Metastatic non-small cell lung cancers (NSCLC) are being treated with immune checkpoint inhibitors (ICI). Nivolumab was approved in 2015, pembrolizumab (pz) /atezolizumab (az) in 2016, pz-chemotherapy (Ch) (pemetrexed + carboplatin) in 2017; durvalumab, pz-Ch (paclitaxel) and az-Ch (bevacizumab, carboplatin, paclitaxel) in 2018. We aim to study population based overall survival (OS) differences before and after these approval. Methods: We used Surveillance, Epidemiology and End Results (SEER) research plus database (Nov 2022 submission,17 registries). Patients aged ≥ 20 years with NSCLC as “distant” (combined summary stage) from 2013-2018 were included. Time was stratified as Pre-ICI from 2013-2014, initial single agent ICI from 2015-2016 (ICI) and new ICI/ICI-Ch from 2017-2018 (n/ICICh). OS in these time periods was calculated using Kaplan Meier (KM) method and were compared with log rank tests. Multivariate analysis was done using cox proportional hazard ratios. p < 0.05 was considered for statistical significance. IBM SPSS was used for analysis. Results: Total of 6375 patients had advanced NSCLC from 2013-2018. 4 and 5-year survival from 2017-2018 was not available due to data up to 2020. The survival difference among three timelines was statistically significant (log rank test, χ 2 = 20.795, p < 0.001). On multivariate analysis, ICI and n/ICICh had significantly lower risk of dying as in table compared to Pre-ICI. Male, age ≥50 years, Black/Asian/Pacific Islanders were at higher risk and who received radiotherapy/chemotherapy had a lower risk of dying. There was no significant difference among Hispanic versus non-Hispanic and among marital status. Conclusions: ICI shows clear survival benefits in advanced NSCLC in this population-based study which supports clinical trials. Racial, gender and older age disparities shown in this study will further help in guiding appropriate measures. Future analysis with new ICI/Ch therapy with new timelines will help show population-based survival benefits after updated database. Table: see text