Evidence map›Paper›PMID 39551068›Full record

ArticleThe Lancet. Oncology2024

Effectiveness and safety of immune checkpoint inhibitors in Black patients versus White patients in a US national health system: a retrospective cohort study.

Sean Miller, Ralph Jiang, Matthew Schipper, Lars G Fritsche, Garth Strohbehn, Beth Wallace, Daria Brinzevich, Virginia Falvello, Benjamin H McMahon, Rafael Zamora-Resendiz and 9 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Trial
  2. Article
  3. Patient-reported quality-of-life outcomes in immune checkpoint inhibitor therapy: addressing gaps, capturing patient experience, and advancing the field.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Review
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Sean MillerDepartment of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Ralph JiangDepartment of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
Matthew SchipperDepartment of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
Lars G FritscheDepartment of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA.
Garth StrohbehnRogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Medicine, Division of Medical Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
Beth WallaceInternal Medicine/Rheumatology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.
Daria BrinzevichRogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
Virginia FalvelloRogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
Benjamin H McMahonTheoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, NM, USA.
Rafael Zamora-ResendizApplied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
Nithya RamnathRogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Department of Medicine, Division of Medical Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA.
Xin DaiComputational Science Initiative, Brookhaven National Laboratory, Upton, NY, USA.
Kamya SankarDepartment of Medicine, Division of Medical Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Donna M EdwardsDepartment of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Steven G AllenDepartment of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
Shinjae YooComputational Science Initiative, Brookhaven National Laboratory, Upton, NY, USA.
Silvia CrivelliApplied Mathematics and Computational Research Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.
Michael D GreenDepartment of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
Alex K BryantDepartment of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA. Electronic address: bralex@med.umich.edu.

Funding

CSRD VA IK2 CX002430
6 · The paper itself

Abstract

backgroundBlack patients were severely under-represented in the clinical trials that led to the approval of immune checkpoint inhibitors (ICIs) for all cancers. The aim of this study was to characterise the effectiveness and safety of ICIs in Black patients.

methodsWe did a retrospective cohort study of patients in the US Veterans Health Administration (VHA) system's Corporate Data Warehouse containing electronic medical records for all patients who self-identified as non-Hispanic Black or African American (referred to as Black) or non-Hispanic White (referred to as White) and received PD-1, PD-L1, CTLA-4, or LAG-3 inhibitors between Jan 1, 2010, and Dec 31, 2023. Effectiveness outcomes were overall survival, time to treatment discontinuation, and time to next treatment. The safety outcome was the frequency of immune-related adverse events; assessed among a random sample of 1000 Black patients and 1000 White patients, 892 pairs were matched on the basis of baseline characteristics using 1:1 exact matching without replacement. After manual chart review, patients who did not receive ICI therapy or who had inadequate follow-up were excluded. The adjusted effect of race on each effectiveness outcome was assessed in the whole ICI-treated cohort with propensity-weighted Cox regression with robust standard errors. Immune-related adverse events outcomes were analysed in the random matched sample with multivariable Cox regression, adjusting for baseline characteristics.

findingsWe identified 26 398 patients, of whom 4943 (18·7%) patients were Black, 21 455 (81·3%) were White, 895 (3·4%) were female, 25 503 (96·6%) were male, 11 859 (45%) had non-small-cell lung cancer, and 26 045 (98·7%) received PD-1 or PD-L1 inhibitors. As of data cutoff (Aug 28, 2024), median follow-up was 40·3 months (95% CI 38·3-42·3) for Black patients and 43·9 months (43·0-45·1) for White patients. Compared with White patients, Black patients had longer time to treatment discontinuation (2-year unadjusted rates 10·7% [95% CI 9·8-11·7] for Black patients vs 8·6% [8·2-9·0] for White patients; adjusted hazard ratio [HR] 0·91, 95% CI 0·87-0·95, p<0·0001), similar time to next treatment (23·5% [22·3-24·8] for Black patients vs 25·6% [25·0-26·2] for White patients; 1·00, 0·95-1·05, p=0·96), and slightly improved overall survival (36·5% [35·2-38·1] for Black patients vs 36·5% [35·8-37·1]; 0·95, 0·90-0·99, p=0·036). 1710 patients (n=862 Black and n=848 White) were analysed for safety outcomes. Compared with White patients, Black patients had a reduced risk of all-grade immune-related adverse events (unadjusted 2-year rate 33·1% [95% CI 28·9-37·1] vs 44·1% [95% CI 39·1-48·7]; adjusted HR 0·75, 95% CI 0·62-0·90, p=0·0026), immune-related adverse events requiring treatment with systemic steroids (0·61, 0·46-0·81, p=0·00051), and immune-related adverse events resulting in permanent ICI discontinuation (0·58, 0·44-0·78, p=0·00024). In exploratory analyses of irAE subtypes, a significant risk reduction in Black patients was found for colitis (0·46, 0·27-0·76, p=0·0026) and hyperthyroidism or hypothyroidism (0·63, 0·44-0·90, p=0·011), and no significant differences were found for any other immune-related adverse event subtypes analysed. Similar results were found in analyses using a steroid-based definition of immune-related adverse events among the entire ICI-treated cohort.

interpretationCompared with White patients, Black patients had similar ICI effectiveness and lower toxicities among those treated in the national VHA system, potentially reflecting an important difference in the therapeutic ratio (ratio of benefit to harm) of ICIs. Our findings of decreased toxicity among Black patients require further investigation to assess their generalisability.

fundingMillion Veteran Program, Office of Research and Development, Veterans Health Administration and the LUNGevity foundation.

Indexed as

Black or African AmericanImmune Checkpoint InhibitorsNeoplasmsWhiteAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeUnited StatesImmune Checkpoint Inhibitors

Identifiers

PMID39551068
PMCPMC12169339

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