Abstract P6-10-02: Black race is associated with worse distant relapse-free survival in breast cancer patients treated with neoadjuvant compared to adjuvant systemic chemotherapy
Authors: Pastoriza JM , Karagiannis GS , Xue X , Lin J , Condeelis JS , Sparanno JA , Rohan TE , Oktay MH 
Published: February 2018

Background: Compared to white women, black women with operable breast cancer treated with primary surgical therapy and adjuvant or neoadjuvant systemic chemotherapy have higher recurrence rates and breast cancer mortality. Large randomized prospective studies did not find significant differences in distant-recurrence free survival (DRFS) and overall survival (OS) between breast cancer patients treated in the adjuvant and neoadjuvant setting for predominantly white populations. However, data indicating that neoadjuvant treatment is equivalent to adjuvant treatment for black breast cancer patients are missing. Here, we first examined racial differences in DRFS among breast cancer patients treated in the neoadjuvant setting at Einstein-Montefiore Center for Cancer Care (EMCCC) in the Bronx, and then investigated if DRFS in black patients treated in the neoadjuvant setting is comparable to DRFS in the adjuvant setting.

Methods: We evaluated DRFS in 241 racially diverse patients with localized or regionally advanced breast cancer treated with neoadjuvant chemotherapy between January 2000 and December 2016. In addition, we evaluated DRFS in 474 white and 701 black patients with localized or regionally advanced breast cancer treated with systemic adjuvant (432 whites, 596 blacks) or neoadjuvant (42 whites, 105 blacks) chemotherapy. Using multivariate Cox proportional hazard models, we generated hazard ratios (HR) and 95% confidence intervals (95%CI) for risk of distant recurrence, with adjustment for age (&lt;50 vs &gt;/50 years), stage (I/II vs III), estrogen receptor (ER) status (+ vs -), HER2/neu overexpression (+ vs. -/equivocal/unknown), triple negative (TN) status (yes vs no), and type of systemic chemotherapy (adjuvant vs. neoadjuvant).

Results: Black patients treated with neoadjuvant systemic chemotherapy had significantly worse DRFS than white patients (HR=2.29; 95%CI=1.02-5.15, p=0.04). DRFS in non-black Hispanics and patients from racial backgrounds other than Hispanic or black compared to whites was not statistically different. Neoadjuvant chemotherapy was associated with worse DRFS compared to adjuvant chemotherapy in black (HR=3.72; 95%CI=4.03-5.81; p=&lt;0.0001), but not in white women.

Conclusion: Black patients with localized breast cancer treated with systemic neoadjuvant chemotherapy not only have inferior DRFS compared to white patients, but also worse DRFS when compared to black patients treated with adjuvant chemotherapy, after adjustment for clinical and pathological covariates. This observation needs to be confirmed in further prospective studies and biologic factors contributing to this finding need to be evaluated.

Citation Format: Pastoriza JM, Karagiannis GS, Xue X, Lin J, Condeelis JS, Sparanno JA, Rohan TE, Oktay MH. Black race is associated with worse distant relapse-free survival in breast cancer patients treated with neoadjuvant compared to adjuvant systemic chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-10-02.