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Racial disparities in treatment patterns and clinical outcomes in patients with HER2-positive metastatic breast cancer.

Rugo HS, Brufsky AM, Ulcickas Yood M, Tripathy D, Kaufman PA, Mayer M, Yoo B, Abidoye OO, Yardley DA - Breast Cancer Res. Treat. (2013)

Bottom Line: In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %).Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2).The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59).

View Article: PubMed Central - PubMed

Affiliation: University of California San Francisco Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, Box 1710, San Francisco, CA, 94143-1710, USA, hrugo@medicine.ucsf.edu.

ABSTRACT
Data characterizing demographics, treatment patterns, and clinical outcomes in black patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) are limited. registHER is a large, observational cohort study of patients (n = 1,001) with HER2-positive MBC diagnosed ≤6 months of enrollment and followed until death, disenrollment, or June 2009 (median follow-up of 27 months). Demographics, treatment patterns, and clinical outcomes were described for black (n = 126) and white patients (n = 793). Progression-free survival (PFS) following first-line therapy and overall survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Black patients were more likely than white patients to be obese (body mass index ≥30), to have diabetes, and to have a history of cardiovascular disease; they were also less likely to have estrogen receptor or progesterone receptor positive disease. In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %). Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2). The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59). This real-world evaluation of a large cohort of patients with HER2-positive MBC shows poorer prognostic factors and independently worse clinical outcomes in black versus white patients. Further research is needed to identify potential biologic differences that could have predictive impact for black patients or that could explain these differences.

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Related in: MedlinePlus

Select clinical characteristics in black and white patients at the time of metastatic breast cancer diagnosis. BMI body mass index, CVD cardiovascular disease, ER estrogen receptor, PR progesterone receptor
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Related In: Results  -  Collection


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Fig1: Select clinical characteristics in black and white patients at the time of metastatic breast cancer diagnosis. BMI body mass index, CVD cardiovascular disease, ER estrogen receptor, PR progesterone receptor

Mentions: Baseline demographics and clinical characteristics for the black and white patients who were followed until death, disenrollment, or the June 2009 data lock date are shown in Table 1. Black patients were more likely to have discontinued due to death and loss to followup compared with white patients (62.7 vs. 53.1 % and 8.7 vs. 4.9 %, respectively). The median follow-up time was 21.0 months for black patients and 28.4 months for white patients. Black patients were slightly younger, had a higher prevalence of obesity (50.8 vs. 32.4 %), and had more than twice the prevalence of diabetes (13.5 vs. 6.4 %) at baseline than white patients. In addition, twice as many black patients had a history of underlying CVD at baseline than did white patients (30.2 vs. 15.8 %) (see Table 1; Fig. 1). Among black patients, hypertension with complications (11.1 %) and other cardiac diseases (20.6 %) were the most commonly reported CVD conditions.Table 1


Racial disparities in treatment patterns and clinical outcomes in patients with HER2-positive metastatic breast cancer.

Rugo HS, Brufsky AM, Ulcickas Yood M, Tripathy D, Kaufman PA, Mayer M, Yoo B, Abidoye OO, Yardley DA - Breast Cancer Res. Treat. (2013)

Select clinical characteristics in black and white patients at the time of metastatic breast cancer diagnosis. BMI body mass index, CVD cardiovascular disease, ER estrogen receptor, PR progesterone receptor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3824350&req=5

Fig1: Select clinical characteristics in black and white patients at the time of metastatic breast cancer diagnosis. BMI body mass index, CVD cardiovascular disease, ER estrogen receptor, PR progesterone receptor
Mentions: Baseline demographics and clinical characteristics for the black and white patients who were followed until death, disenrollment, or the June 2009 data lock date are shown in Table 1. Black patients were more likely to have discontinued due to death and loss to followup compared with white patients (62.7 vs. 53.1 % and 8.7 vs. 4.9 %, respectively). The median follow-up time was 21.0 months for black patients and 28.4 months for white patients. Black patients were slightly younger, had a higher prevalence of obesity (50.8 vs. 32.4 %), and had more than twice the prevalence of diabetes (13.5 vs. 6.4 %) at baseline than white patients. In addition, twice as many black patients had a history of underlying CVD at baseline than did white patients (30.2 vs. 15.8 %) (see Table 1; Fig. 1). Among black patients, hypertension with complications (11.1 %) and other cardiac diseases (20.6 %) were the most commonly reported CVD conditions.Table 1

Bottom Line: In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %).Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2).The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59).

View Article: PubMed Central - PubMed

Affiliation: University of California San Francisco Helen Diller Family Comprehensive Cancer Center, 1600 Divisadero Street, Box 1710, San Francisco, CA, 94143-1710, USA, hrugo@medicine.ucsf.edu.

ABSTRACT
Data characterizing demographics, treatment patterns, and clinical outcomes in black patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) are limited. registHER is a large, observational cohort study of patients (n = 1,001) with HER2-positive MBC diagnosed ≤6 months of enrollment and followed until death, disenrollment, or June 2009 (median follow-up of 27 months). Demographics, treatment patterns, and clinical outcomes were described for black (n = 126) and white patients (n = 793). Progression-free survival (PFS) following first-line therapy and overall survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Black patients were more likely than white patients to be obese (body mass index ≥30), to have diabetes, and to have a history of cardiovascular disease; they were also less likely to have estrogen receptor or progesterone receptor positive disease. In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %). Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2). The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59). This real-world evaluation of a large cohort of patients with HER2-positive MBC shows poorer prognostic factors and independently worse clinical outcomes in black versus white patients. Further research is needed to identify potential biologic differences that could have predictive impact for black patients or that could explain these differences.

Show MeSH
Related in: MedlinePlus