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Social determinants of health and CDK4/6 inhibitor use and outcomes among patients with metastatic breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

Survival outcomes in metastatic breast cancer (MBC) have improved due to novel agents such as CDK4/6 inhibitors (CDK4/6i). Nevertheless, Black patients and patients with lower socioeconomic status (SES) continue to bear a disproportionate mortality burden.

Methods

We conducted a retrospective analysis of EHR-derived data from the Flatiron Health Database (FHD). A dataset was constructed to include Black/African-American (Black/AA) and White patients with hormone receptor (HR)-positive, HER2-negative MBC. Outcomes included CDK4/6i use (overall and first-line), and rates of leukopenia, dose reduction, and time on treatment for first-line CDK4/6i. Multivariable logistic regression was used to evaluate factors associated with use and outcomes.

Results

A total of 6802 patients with MBC were included, of which 5187 (76.3%) received CDK4/6i. Of those, 3186 (61.4%) received CDK4/6i first-line. Overall, 86.7% of patients were categorized as White and 13.3% as Black/AA; 22.4% were > 75 years old; 12.6% were treated at an academic site; 3.3% had Medicaid insurance. In addition to advanced age and poorer performance status, lower use of CDK4/6i was associated with Black/AA vs White race (72.9% vs 76.8%; OR 0.83, 95% CI 0.70–0.99, p = 0.04) and Medicaid vs commercial insurance (69.6% vs 77.4%; OR: 0.68, 95% CI 0.49–0.95, p = 0.02). Odds of CDK4/6i use were twofold higher for patients treated at an academic center (p < 0.001). Rates of CDK4/6i-induced leukopenia and dose reductions did not differ significantly by race, insurance type, or treatment site. Time on CDK4/6i was significantly lower among Medicaid patients (395 days) than patients with commercial insurance (558 days) or Medicare (643 days) (p = 0.03).

Conclusion

This analysis of real-world data suggests that Black race and lower SES are associated with decreased CDK4/6i use. However, among patients treated with CDK4/6i, subsequent toxicity outcomes are similar. Efforts to ensure access to these life-prolonging medications are warranted.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

This research was partially funded by the American Cancer Society (DLH) and the Breast Cancer Research Foundation (DLH).

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Authors and Affiliations

  1. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Claire Sathe, Melissa K. Accordino, David DeStephano, Jason D. Wright & Dawn L. Hershman

  2. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Mansi Shah

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  1. Claire Sathe
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  2. Melissa K. Accordino
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  3. David DeStephano
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Correspondence to Claire Sathe.

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Sathe, C., Accordino, M.K., DeStephano, D. et al. Social determinants of health and CDK4/6 inhibitor use and outcomes among patients with metastatic breast cancer. Breast Cancer Res Treat 200, 85–92 (2023). https://doi.org/10.1007/s10549-023-06957-5

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