title: Impact of race, ethnicity, and BMI on achievement of pathologic complete response following neoadjuvant chemotherapy for breast cancer: a pooled analysis of four prospective Alliance clinical trials (A151426).
abstract: Previous studies demonstrated poor response to neoadjuvant systemic therapy (NST) for breast cancer among black women and women who are overweight or obese, but this may be due to chemotherapy underdosing. We assessed associations of race, ethnicity, and body mass index (BMI) with pathologic complete response (pCR) in clinical trial populations. 1797 women enrolled in four NST trials (CALGB 40601, 40603; ACOSOG Z1041, Z1071) were included. Tumor subtypes were defined by estrogen receptor (ER) and HER2 status. Logistic regression generated odds ratios (OR) and 95 % confidence intervals (CI) for the associations of race, ethnicity, and BMI with in-breast pCR adjusting for subtype, study arm, lymph node status, tumor size, and tumor grade. 253 (14.1 %) were black, 199 (11.1 %) Hispanic, 520 (28.9 %) overweight, and 743 (41.4 %) obese. Compared to whites, Blacks and Hispanics were more likely to be obese and Blacks were more likely to have triple-negative cancer. pCR rates differed significantly by tumor subtype. In multivariate analyses, neither race (black vs white: OR 1.18, 95 % CI 0.85-1.62) nor ethnicity (Hispanic vs non-Hispanic; OR 1.30, 95 % CI 0.67-2.53) were significant predictors of pCR overall or by subtype. Overweight and obese women had lower pCR rates in ER+/HER2+, but higher pCR rates in ER-/HER2+ cancers. There was no difference in pCR according to race or ethnicity. Overall, there was no major difference in pCR rates by BMI. These findings suggest that pCR with optimally dosed NST is a function of tumor, rather than patient, biology.
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. ewarner@mgh.harvard.edu.
authors.forename: Erica T
authors.initials: ET
authors.lastname: Warner
authors.affiliation: Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA.
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.affiliation: Alliance Statistics and Data Center, 1216 Second St. SW, Rochester, MN, 55902, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Strand
authors.affiliation: Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Boughey
authors.affiliation: University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Aman U
authors.initials: AU
authors.lastname: Buzdar
authors.affiliation: University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.affiliation: Women and Infants Hospital of Rhode Island and Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Sikov
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.|Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Partridge
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000208:ethnology* / Q000378:metabolism; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D011446:Prospective Studies; D044469:Racial Groups; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; C508053:ERBB2 protein, human
keywords: Body mass index; Breast cancer; Ethnicity; Pathologic complete response; Race