Racial differences in clinical outcomes from metastatic breast cancer: a pooled analysis of CALGB 9342 and 9840--Cancer and Leukemia Group B.
OBJECTIVE
African American women are more likely to be diagnosed with metastatic breast cancer at the time of presentation than whites, and have shorter survival once diagnosed. This study examines racial differences in clinical outcomes in the setting of two large cooperative group randomized clinical trials.


METHODS
The study cohort consisted of 787 white (80%) and 195 African American (20%) patients with metastatic breast cancer enrolled in two successive Cancer and Leukemia Group B (CALGB) trials using taxanes in the metastatic setting. Differences in overall survival (OS), response incidence, and time to treatment failure (TTF) were examined by race. In addition, differences in the incidence of baseline and treatment-related toxicities were examined.


RESULTS
With 779 deaths (166 African Americans and 613 whites), median OS was 14.3 months for African Americans and 18.75 months for whites (hazard ratio [HR] = 1.37; 95% CI, 1.15 to 1.63). When adjusted for prognostic factors, African Americans had a 24% increase in the hazard of death compared with whites (HR = 1.24; 95% CI, 1.02 to 1.51). No significant differences in TTF or overall response to therapy were seen. No clinically significant toxicity differences were seen.


CONCLUSIONS
African Americans with metastatic breast cancer have an increased hazard of death compared with whites despite the receipt of similar per-protocol treatment, but experience no differences in TTF or overall response to therapy. We hypothesize that more direct and robust measures of comorbidities, and perhaps other factors such as receipt of subsequent therapy could help further explain the observed survival difference.
The University of Chicago Medical Center, 5841 South Maryland Ave, MC 2115, Chicago, IL 60637-1470, USA. bpolite@medicine.bsd.uchicago.edu
Blase N
BN
Polite
Constance
C
Cirrincione
Gini F
GF
Fleming
Donald A
DA
Berry
Andrew
A
Seidman
Hyman
H
Muss
Larry
L
Norton
Charles
C
Shapiro
Kamal
K
Bakri
Kelly
K
Marcom
Diana
D
Lake
Joel H
JH
Schwartz
Clifford
C
Hudis
Eric P
EP
Winer
D000328:Adult; D001741:Black or African American; D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009362:Neoplasm Metastasis; D017239:Paclitaxel / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D044465:White People
D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel