Abstract 1961: Stratifying high-risk patients, quantifying therapy efficacy, and detecting treatment/racial disparity in triple-negative breast cancer (TNBC) at Sentara-EVMS-VOA
Authors: Drake Taylor N. , Euker Brandon , Tang-Tan Angela M. , Lee Caroline Dasom , Breeding Emily L. , Winston Janet S. , Samli Billur , Jansen Rick J. , Danso Michael , Guye Mary L. , Hoefer Richard A. , Tang Amy H. 
Published: April 2023

Introduction: Metastatic breast cancer (MBC) is the 2nd leading cause of cancer-related deaths in American women. While improvements in local and systemic therapies have significantly improved survival, 43,250 MBC patients are expected to succumb to their disease in the United States in 2022 alone. Triple-negative breast cancer (TNBC) represents 15% of all breast cancer and is defined by the lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). TNBC is the most aggressive subtype of breast cancer, known for its early relapse rate, chemo-resistance, and reduced survival. TNBC is also nearly twice as common in African American (AA) than in White women. In this study, we aim to ascertain the cancer disparity in a large cohort of Black/AA TNBC patients compared to their White counterparts in Hampton Roads, Virginia, as well as to the national SEER database.

Methods: A retrospective chart review and survival study of 554 TNBC patients who received standard of care (SOC) treatment at Sentara-EVMS-VOA was performed. Kaplan-Meier survival curves were generated. Statistical analyses were conducted to determine if any clinicopathologic parameters, chemotherapy regimens, insurance, or socioeconomic status could be used to predict patient survival and risk stratify Black/AA and White TNBC patients in this Sentara cohort.

Results: According to the national SEER TNBC database, 5-year survival rates for Black/AA and Whites are reported as 71.65% and 78.98%, respectively, compared to 70.33% and 75.53% within our local TNBC cohort. The Kaplan-Meier curve, which stratified our TNBC patients by race, predicted significant reduction in breast cancer-specific survival among Black/AA patients as compared to their White counterparts at all TNBC stages, especially in advanced and metastatic settings. This disparity is notably pronounced at stages II and III, as the Black/AA survival curves trend below that of the White TNBC patients for years following surgical intervention. A higher percentage of Black/AA patients were uninsured or under Medicaid coverage and did not receive standard AC-T regimens, particularly for TNBC patients with stage II disease, likely contributing to a reduced 5-year survival in the Black/AA TNBC cohort. We detected racial disparity in prescription of monotherapy or combination chemotherapy that might have also linked to reduced survival in the Black/AA patients from the Sentara catchment areas.

Conclusion: Low socioeconomic status is a major impediment for access to health care. Multipronged combination chemotherapy regimens are critical in treating high-risk and high-grade TNBC patients. Therefore, it is imperative that Medicaid coverage includes AC-T regimens to improve TNBC survival, especially in our Black/AA patients in Hampton Roads, Virginia.

Citation Format: Taylor N. Drake, Brandon Euker, Angela M. Tang-Tan, Caroline Dasom Lee, Emily L. Breeding, Janet S. Winston, Billur Samli, Rick J. Jansen, Michael Danso, Mary L. Guye, Richard A. Hoefer, Amy H. Tang. Stratifying high-risk patients, quantifying therapy efficacy, and detecting treatment/racial disparity in triple-negative breast cancer (TNBC) at Sentara-EVMS-VOA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1961.