Responses to neoadjuvant endocrine therapy for advanced breast cancer differ by race
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Black women with advanced-stage hormone receptor-positive breast cancer experienced poor response to treatment with neoadjuvant endocrine therapy compared with white women with similar disease presentation, according to study results.
The findings, presented during American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, also showed disparities in social determinants of health, such as income and insurance status.
Background
Mortality differences between Black and white women with hormone receptor-positive breast cancer prompted researchers to conduct the study, according to Veronica Jones, MD, assistant professor in the department of surgery in the division of breast surgery at City of Hope.
“Black women are four times more likely to die,” Jones told Healio. “Since endocrine therapy is a mainstay treatment in treating hormone receptor-positive breast cancer, we wanted to examine if Black and white women respond differently to this medication as a potential driver of the mortality disparity. Looking at endocrine therapy in the neoadjuvant setting allows us to answer this question since it is a way to look at response directly and immediately without waiting for recurrence.”
Researchers sought to compare changes in tumor size and nodal status after neoadjuvant endocrine therapy among 365 Black and 3,521 white women with stage I to stage III hormone receptor-positive breast cancer included in the National Cancer Database between 2004 and 2017.
Findings
Results showed Black women had been disproportionately excluded from receipt of neoadjuvant therapy (OR = 1.8; 95% CI, 1.6-1.9). However, Black women who received neoadjuvant endocrine therapy had a longer median duration of treatment than white women (128 days vs. 114 days) and a 1.5-times higher likelihood of receiving neoadjuvant endocrine therapy for more than 24 weeks.
Researchers additionally found Black women had a 1.6-times (95% CI, 1.3-2.1) higher likelihood of having cancer detected in lymph nodes, a 1.5-times (95% CI, 1.1-2) higher likelihood of being diagnosed with stage III disease and a 1.5-times (95% CI, 1.2-1.8) higher likelihood of being treated with neoadjuvant endocrine therapy for less than 24 weeks.
Overall, 0.8% of tumors had been downstaged to an in situ lesion or eliminated after neoadjuvant endocrine therapy, and 2.9-times more Black women experienced tumor downstaging (from stage I or stage II) or elimination. However, researchers found that 0.9% of tumors had been upstaged to stage IV, and only two of those tumors had been originally diagnosed as stage II or stage III. Moreover, Black women had a 2.6-times higher likelihood of experiencing tumor upstaging compared with white women.
Multivariable analysis revealed race as a significant predictor of downstaging after adjustment for neoadjuvant endocrine therapy and clinical stage (OR = 2.85; P = .016)
Implications
Researchers plan to further examine what makes hormone receptor-positive breast cancer more aggressive in Black women and ways to mitigate this disparity, Jones said.
“We plan to do this through a genomic and therapeutic lens through clinical trials to determine the best treatment in this patient population,” she told Healio. “There is still a lot of work needed to address breast cancer disparities on many levels, from the social landscape and the genomic front, as well. The overall takeaway message is that breast cancer treatment, even for the supposedly less aggressive subtypes, cannot be a ‘one-size-fits-all’ approach. We must take the necessary steps to design better therapies for populations that need it most.”
References :
- Jones V, et al. Differential response to neoadjuvant endocrine therapy for Black and white women in NCDB. Presented at: American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 16-19, 2022; Philadelphia.
- Neoadjuvant endocrine therapy may elicit differential responses in black vs. white women with breast cancer (press release). Available at: www.aacr.org/about-the-aacr/newsroom/news-releases/neoadjuvant-endocrine-therapy-may-elicit-differential-responses-in-black-vs-white-women-with-breast-cancer/. Published Sept. 16, 2022. Accessed Sept. 19, 2022.
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Jones V, et al. Differential response to neoadjuvant endocrine therapy for Black and white women in NCDB. Presented at: American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Sept. 16-19, 2022; Philadelphia.
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