title: Exploring racial differences in outcome and treatment for metastatic colorectal cancer: results from a large prospective observational cohort study (BRiTE).
abstract: BACKGROUND
  African Americans are more likely to be diagnosed with metastatic colorectal cancer than whites and have shorter survival once they are diagnosed. In this analysis, the authors examined racial differences in clinical outcomes among patients with metastatic colorectal cancer (mCRC) who received bevacizumab.
  
  
  METHODS
  The study cohort consisted of 1589 white patients (81.4%) and 227 African American patients (11.6%) with mCRC who received front-line bevacizumab therapy and who were enrolled in a large, predominantly community-based, prospective, observational cohort study. Differences in time-to-event endpoints and response rates were examined by race. Differences in the incidence of baseline and treatment-related toxicities associated with bevacizumab also were examined. Finally, differences in patterns of care by race were explored.
  
  
  RESULTS
  The median overall survival was 22.6 months for African Americans and 22.9 months for whites, and the median progression-free survival was 9.5 months for African Americans and 9.8 months for whites. Response rates (complete responses plus partial responses) were 37.5% for African Americans and 46.3% for whites (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.90). African Americans had higher rates of baseline diabetes (18.9% vs 11%; P = .002), higher rates of hypertension (52.9% vs 41.4%; P = .001), and worsening hypertension while on therapy (13.7% vs 8.9%; P = .02), but no differences in on-treatment arterial thromboembolic events were observed.
  
  
  CONCLUSIONS
  This large observational cohort study of patients with mCRC demonstrated that, when treated in a similar fashion with modern chemotherapy, African Americans and whites had equivalent cancer outcomes. No significant differences in bevacizumab-related toxicity or patterns of care were observed between African Americans and whites. The lower response rate among African Americans deserves further study.
authors.affiliation: Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, Illinois 60637-1470, USA. bpolite@medicine.bsd.uchicago.edu
authors.forename: Blase N
authors.initials: BN
authors.lastname: Polite
authors.forename: Amy
authors.initials: A
authors.lastname: Sing
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sargent
authors.forename: Axel
authors.initials: A
authors.lastname: Grothey
authors.forename: Jordan
authors.initials: J
authors.lastname: Berlin
authors.forename: Mark
authors.initials: M
authors.lastname: Kozloff
authors.forename: Shibao
authors.initials: S
authors.lastname: Feng
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000068258:Bevacizumab; D044383:Black People; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000208:ethnology* / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab