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A comparison of complete pathologic response rates following neoadjuvant chemotherapy among South African breast cancer patients with and without concurrent HIV infection

  • Epidemiology
  • Published:
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Abstract

Purpose

Among patients diagnosed with breast cancer (BC), women also living with HIV (WLWH) have worse survival than women without HIV. Chronic HIV infection may interfere with the effectiveness of BC treatment, contributing to this disparity. We attempted to determine the impact of HIV infection on response to neoadjuvant chemotherapy (NACT) among South African women with BC.

Methods

We evaluated women from the South African Breast Cancer and HIV Outcomes cohort study who had stage I–III disease, initiated NACT, underwent definitive breast surgery, and had available surgical pathology reports. We compared pathologic complete response (pCR) rates among women with and without HIV infection, using multivariable logistic regression to control for differences in tumor characteristics. We also evaluated the impact of HIV infection on pCR within subgroups based on patient and tumor factors.

Results

Of 715 women, the 173 (24.2%) WLWH were less likely to achieve pCR than women without HIV (8.7% vs 16.4%, [odds ratio (OR) 0.48, 95% confidence interval (95% CI) 0.27–0.86]). WLWH continued to have lower likelihood of achieving pCR on multivariable analysis (OR 0.52, 95% CI 0.28–0.98). A similar pattern was seen within subgroups, although HIV infection appeared to affect pCR more in ER/PR-positive BC (OR 0.24, 95% CI 0.08–0.71) than in ER/PR-negative BC (OR 0.94, 95% CI 0.39–2.29).

Conclusion

WLWH were less like to achieve pCR following NACT for BC than women without HIV. This reduced response to systemic therapy may contribute to the poorer BC outcomes seen in WLWH.

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Data Availability

The datasets generated during and analyzed during the current study are not publicly available due to local national policy but are available from the corresponding author on reasonable request.

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Funding

This study was funded by the National Cancer Institute of the National Institutes of Health (Grant Number NCI 1R01CA192627 to J.S.J, M.J., A.I.N. and P.R. and NCI 3P30CA13696 to A.I.N.), and the University of Witwatersrand/South African Medical Research Council (University of the Witwatersrand Common Epithelial Cancer Research Centre Grant to P.R.).

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Author notes

  1. Sarah Nietz and Daniel S. O’Neil have contributed equally to the preparation of this manuscript.

Authors and Affiliations

  1. Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, Gauteng, South Africa

    Sarah Nietz, Boitumelo Phakathi & Herbert Cubasch

  2. Sylvester Comprehensive Cancer Center, University of Miami Health System, 1121 NW 14th Street, SMOB, Rm 245B, Miami, FL, 33150, USA

    Daniel S O’Neil

  3. Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, USA

    Daniel S O’Neil

  4. SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Oluwatosin Ayeni & Maureen Joffe

  5. Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, 31 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa

    Oluwatosin Ayeni, Wenlong Carl Chen, Maureen Joffe, Paul Ruff, Witness Mapanga, Tobias Chirwa & Herbert Cubasch

  6. National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa

    Wenlong Carl Chen

  7. Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, 9 Jubilee Road, Parktown, Johannesburg, 2193, South Africa

    Wenlong Carl Chen

  8. South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand, Johannesburg, South Africa

    Maureen Joffe

  9. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, USA

    Judith S Jacobson & Alfred I Neugut

  10. Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th Street, Room 732, New York, NY, 10032, USA

    Judith S Jacobson & Alfred I Neugut

  11. Division of Medical Oncology, Columbia University Medical Center, 722 W 168th Street, Room 725, New York, NY, 10032, USA

    Alfred I Neugut

  12. Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa

    Paul Ruff

  13. Departments of Surgery and Oncology, Inkosi Albert Luthuli Central Hospital, Private Bag X03, Mayville, Durban, 4058, South Africa

    Ines Buccimazza & Urishka Singh

  14. Departments of Surgery and Oncology, Grey’s Hospital, University of KwaZulu Natal, Townbush Road, Pietermaritzburg, 3100, KZN, South Africa

    Sharon Čačala & Laura Stopforth

  15. Department of Surgery, Ngwelezana Hospital, Thanduyise Road, Empangeni, 3880, KZN, South Africa

    Sharon Čačala

  16. School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa

    Tobias Chirwa

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  1. Sarah Nietz
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  2. Daniel S O’Neil
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Contributions

All authors contributed to the initial design of this study and interpretation of the data. SN, MJ, PR, IB, US, SČ, LS, and HC all participated in patient recruitment and contributed data. SN, DSO, OA, and WCC conducted the primary data analysis. DSO and SN wrote the initial manuscript and prepared the included tables and figures. AIN, PR, and HC provided supervision. All authors contributed revisions to the manuscript and approved of the final manuscript prior to submission.

Corresponding author

Correspondence to Daniel S O’Neil.

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Conflict of interest

Dr. Neugut has received consulting fees from Otsuka, UBC, Hospira and EHE International. Dr. Ruff has received honoraria from Sanofi, Amgen, and Roche and research funding from Amgen, Sanofi, Merck, Novartis. All other authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of Columbia University in New York City and the human research ethics committees of the University of Witwatersrand in Johannesburg and the University of KwaZulu Natal in Durban and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human and animal participants

This article does not contain any studies with animals performed by any of the authors.

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Nietz, S., O’Neil, D.S., Ayeni, O. et al. A comparison of complete pathologic response rates following neoadjuvant chemotherapy among South African breast cancer patients with and without concurrent HIV infection. Breast Cancer Res Treat 184, 861–872 (2020). https://doi.org/10.1007/s10549-020-05889-8

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