Breast Cancer Research and Treatment

, Volume 159, Issue 1, pp 109–118 | Cite as

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)

  • Erica T. WarnerEmail author
  • Karla V. Ballman
  • Carrie Strand
  • Judy C. Boughey
  • Aman U. Buzdar
  • Lisa A. Carey
  • William M. Sikov
  • Ann H. Partridge


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.


Breast cancer Race Ethnicity Body mass index Pathologic complete response 



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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Erica T. Warner
    • 1
    Email author
  • Karla V. Ballman
    • 2
  • Carrie Strand
    • 3
  • Judy C. Boughey
    • 4
  • Aman U. Buzdar
    • 5
  • Lisa A. Carey
    • 6
  • William M. Sikov
    • 7
  • Ann H. Partridge
    • 8
    • 9
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Alliance Statistics and Data CenterRochesterUSA
  4. 4.Mayo ClinicRochesterUSA
  5. 5.University of Texas MD Anderson Cancer CenterHoustonUSA
  6. 6.University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer CenterChapel HillUSA
  7. 7.Women and Infants Hospital of Rhode Island and Alpert Medical School of Brown UniversityProvidenceUSA
  8. 8.Brigham and Women’s HospitalBostonUSA
  9. 9.Dana-Farber Cancer InstituteBostonUSA

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