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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)

  • Epidemiology
  • Published:
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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.

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Acknowledgments

The authors would like to acknowledge Dr. Olwen Hahn for her contributions to the included studies. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under the Award Number UG1CA189823 (to the Alliance for Clinical Trials in Oncology NCORP Grant), U10CA180790, U10CA180838, U10CA180858, and U10CA180867. Dr. Warner was supported by NCI Grant K01CA188075. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The study sponsors had no role in study design, collection, analysis, and interpretation of data, writing the report, or the decision to submit the report for publication. Dr. Warner had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Erica T. Warner

  2. Weill Cornell Medical College, 402 East 67th Street, New York, NY, 10065, USA

    Karla V. Ballman

  3. Alliance Statistics and Data Center, 1216 Second St. SW, Rochester, MN, 55902, USA

    Carrie Strand

  4. Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Judy C. Boughey

  5. University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Aman U. Buzdar

  6. University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA

    Lisa A. Carey

  7. Women and Infants Hospital of Rhode Island and Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA

    William M. Sikov

  8. Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Ann H. Partridge

  9. Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Ann H. Partridge

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  1. Erica T. Warner
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Warner, E.T., Ballman, K.V., Strand, C. et al. 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). Breast Cancer Res Treat 159, 109–118 (2016). https://doi.org/10.1007/s10549-016-3918-5

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