Factors Influencing Immunotherapy Utilization in Stage IV Pancreatic Cancer: Impact of Race and Socioeconomics in the U.S.

Background: Pancreatic ductal adenocarcinoma (PDAC), a highly lethal cancer with a poor prognosis, is expected to become the second deadliest cancer in the United States by 2030. Despite advancements in treatment modalities, the survival rates of patients with PDAC have remained low. Immunotherapy has emerged as a promising treatment for various cancers; however, its utilization in PDAC has been limited due to various challenges, including resistance mechanisms and the advanced stage at which most patients are diagnosed.

Methods: We analyzed data from the National Cancer Database (NCDB) from 2010 to 2017, focusing on the impact of race, insurance status, and socioeconomic factors among patients with stage IV PDAC using logistic regression analyses.

Results: Among 109,663 patients with stage IV PDAC, 421 (0.38%) received immunotherapy. The recipients were younger (median age 63 vs. 68 years, p < 0.001) and more likely to be white (87.4% vs. 82.1%). Patients with private insurance or Medicare (p < 0.001), and those earning more than $60 k annually (51.0% vs. 36.4%, p < 0.001) were more likely to receive immunotherapy. Treatment was more likely in academic/research programs than in community cancer programs (53.0% vs. 33.4%, p < 0.001). On multivariate analysis, Black patients had lower odds of receiving immunotherapy than Caucasian patients (OR: 0.74 [95% CI: 0.601-0.882], p = 0.019). Higher income was also a significant predictor of immunotherapy utilization (highest vs. lowest income quartile: OR, 2.228 [95% CI: 1.422-3.491], p < 0.001).

Conclusions: This study revealed significant disparities in immunotherapy access for stage IV PDAC based on race, socioeconomic status, and geographic location in the United States, highlighting the need for intervention to promote equitable access to this promising treatment modality.