Breast Cancer Res Treat. 2022 Jan 09; doi: 10.1007/s10549-021-06506-y. Epub 2022 Jan 09.

Lack of racial differences in clinical outcomes of breast cancer patients receiving neoadjuvant chemotherapy: a single academic center study.

Breast cancer research and treatment

Maithreyi Sarma, Stuthi Perimbeti, Samar Nasir, Kristopher Attwood, Ankita Kapoor, Tracey O'Connor, Amy Early, Ellis G Levine, Kazuaki Takabe, Pawel Kalinski, Christine Ambrosone, Thaer Khoury, Song Yao, Shipra Gandhi

PMID: 35000093 DOI: 10.1007/s10549-021-06506-y

Abstract

PURPOSE: To examine the association between race and clinical outcomes (pathological complete response [pCR]; recurrence-free survival [RFS], and overall survival [OS]) in patients diagnosed with triple-negative (TNBC) or HER2-positive breast cancer treated with neoadjuvant chemotherapy (NAC).

METHODS: Patients who self-identified as non-Hispanic white (NHW) or non-Hispanic Black (NHB) and were diagnosed with Stage I-III TNBC (n = 171 including 124 NHW and 47 NHB) and HER2-positive (n = 161 including 136 NHW and 25 NHB) breast cancer who received NAC from 2000 to 2018 at Roswell Park Comprehensive Cancer Center were included. Associations of race with pCR and survival outcomes were evaluated using logistic and Cox regression models, respectively.

RESULTS: There was no statistically significant difference in pCR between NHB and NHW patients with TNBC (31.9 vs 29.8%; OR: 1.11, 95% CI 0.54-2.29) or HER2-positive breast cancer (36.0 vs 39.7%; OR: 0.87, 95% CI 0.36-3.11). After controlling for potential confounders, including age, stage, treatment regimens, insurance status, and comorbidities, no statistically significant difference in OS or RFS was observed between NHB and NHW patients within either subtype.

CONCLUSION: TNBC or HER2-positive breast cancer patients treated at a single academic center in Buffalo, NY, showed similar outcomes independent of patients' race. Given the known genetic diversity of African American ancestry in the US, further studies investigating the interplay between race, geography, and clinical outcomes are warranted.

© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords: Breast cancer; Clinical outcomes; Neoadjuvant chemotherapy; Racial disparity

References

1. Breast SEER 5 year survival rates 2011–2017. 2021 - PubMed
2. Siddharth S, Sharma D (2018) Racial disparity and triple-negative breast cancer in african-american women: a multifaceted affair between obesity, biology, and socioeconomic determinants. Cancers 10(12) - PubMed
3. Cortazar P et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 384(9938):164–172 - PubMed
4. Killelea BK et al (2015) Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the national cancer data base. J Clin Oncol 33(36):4267–4276 - PubMed
5. Tichy JR et al (2015) Race, response to chemotherapy, and outcome within clinical breast cancer subtypes. Breast Cancer Res Treat 150(3):667–674 - PubMed
6. Dawood S et al (2009) Triple receptor-negative breast cancer: the effect of race on response to primary systemic treatment and survival outcomes. J Clin Oncol 27(2):220–226 - PubMed
7. Bryc K et al (2015) The genetic ancestry of African Americans, Latinos, and European Americans across the United States. Am J Hum Genet 96(1):37–53 - PubMed
8. Elston CW, Ellis IO (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology 19(5):403–410 - PubMed
9. Cserni G (2020) Histological type and typing of breast carcinomas and the WHO classification changes over time. Pathologica 112(1):25–41 - PubMed
10. Harvey JM et al (1999) Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol 17(5):1474–1481 - PubMed
11. Wolff AC et al (2013) Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol 31(31):3997–4013 - PubMed
12. Balmanoukian A et al (2009) African American women who receive primary anthracycline- and taxane-based chemotherapy for triple-negative breast cancer suffer worse outcomes compared with white women. J Clin Oncol 27(22):e35–e37; author reply e38–9 - PubMed
13. Usiskin I et al (2021) Association of relative dose intensity with BMI and pathologic complete response in patients treated with neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 186(1):191–197 - PubMed
14. Zhang L et al (2018) Impact of chemotherapy relative dose intensity on cause-specific and overall survival for stage I-III breast cancer: ER+/PR+, HER2- vs. triple-negative. Breast Cancer Res Treat 169(1):175–187 - PubMed
15. Warner ET et al (2016) Impact of race, ethnicity, and BMI on achievement of pathologic complete response following neoadjuvant chemotherapy for breast cancer: a pooled analysis of four prospective Alliance clinical trials (A151426). Breast Cancer Res Treat 159(1):109–118 - PubMed
16. Artiga S, Orgera K, Damico A, Changes in health coverage by race and ethnicity since the ACA, 2010–2018. 2020 March 5th]. https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/ - PubMed
17. Masuda N et al (2017) Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med 376(22):2147–2159 - PubMed
18. von Minckwitz G et al (2019) Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med 380(7):617–628 - PubMed
19. Schmid P et al (2020) Pembrolizumab for early triple-negative breast cancer. N Engl J Med 382(9):810–821 - PubMed
20. Griggs JJ et al (2003) Racial disparity in the dose and dose intensity of breast cancer adjuvant chemotherapy. Breast Cancer Res Treat 81(1):21–31 - PubMed

Publication Types

• Journal Article

Grant support

• P30CA16056/National Cancer Institute Cancer Center Support Grant
• KL2TR001413 UL1TR001412/TR/NCATS NIH HHS/United States