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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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Analysis of overall survival (OS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor
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Fig4: Analysis of overall survival (OS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor

Mentions: In PFS and OS analyses within subcategories of baseline and clinical characteristics (ER/PR status, BMI category, history of CVD, other disease history, metastatic site, and stage at initial diagnosis), as well as treatment patterns (first-line trastuzumab or adjuvant trastuzumab; taxanes or anthracyclines for metastatic disease), the median PFS and OS consistently favored white patients (Figs. 3, 4). There was a trend toward poorer PFS and OS in black patients compared with white patients for both ER/PR-positive and ER/PR-negative statuses.Fig. 3


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)

Analysis of overall survival (OS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Analysis of overall survival (OS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor
Mentions: In PFS and OS analyses within subcategories of baseline and clinical characteristics (ER/PR status, BMI category, history of CVD, other disease history, metastatic site, and stage at initial diagnosis), as well as treatment patterns (first-line trastuzumab or adjuvant trastuzumab; taxanes or anthracyclines for metastatic disease), the median PFS and OS consistently favored white patients (Figs. 3, 4). There was a trend toward poorer PFS and OS in black patients compared with white patients for both ER/PR-positive and ER/PR-negative statuses.Fig. 3

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