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Racial disparities in neutrophil counts among patients with metastatic breast cancer during treatment with CDK4/6 inhibitors

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

Abstract

Purpose

The three CDK4/6 inhibitors (CDK4/6i) approved for use in HR-positive/HER2-negative metastatic breast cancer (MBC), palbociclib, ribociclib, and abemaciclib, are generally well tolerated; however, neutropenia is a common toxicity. Within the general population, neutropenia has been shown to be more common in individuals of African descent. The landmark CDK4/6i trials in MBC lacked racial diversity in their patient populations. We aimed to assess the toxicity profiles of CDK4/6is in a racially diverse population.

Methods

We conducted a retrospective study at Montefiore Medical Center in patients with HR-positive/HER2-negative MBC prescribed CDK4/6i as first or subsequent line therapy between January 2015 and April 2020. Baseline characteristics and laboratory data at various treatment timepoints were collected.

Results

The final analysis included 182 patients, of whom 46% were Black. Baseline absolute neutrophil count (ANC) was lower in the Black vs. Non-Black cohort (p = 0.001) but the change in ANC from baseline (delta-ANC) was smaller in the Black cohort, and the ANC at different treatment timepoints was similar between groups. There was no difference in the rate of infection or number of dose delays/reductions between racial groups. We did not find any difference in PFS between Black and Non-Black groups, regardless of the presence of CDK4/6i-induced neutropenia.

Conclusion

We analyzed toxicity profiles of 182 patients with HR-positive/HER2-negative MBC treated with CDK4/6i. Despite the lower baseline ANC seen in our Black cohort, treatment toxicities were similar between racial groups. Long-term outcomes with CDK4/6i therapy, measured by PFS, were similar between Black vs. Non-Black patients.

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Data availability

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

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Acknowledgements

The manuscript development is supported by The Einstein Paul Calabresi Career Development Program (NIH 5K12CA132783-08) and NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA (Grant Number UL1TR001073).

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Ashley Schreier & Laura Munoz-Arcos

  2. Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, USA

    Alvaro Alvarez

  3. Department of Medical Oncology, Mount Sinai Health System, New York, NY, USA

    Joseph A. Sparano

  4. Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Jesus D. Anampa

Authors
  1. Ashley Schreier
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  2. Laura Munoz-Arcos
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  3. Alvaro Alvarez
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  4. Joseph A. Sparano
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  5. Jesus D. Anampa
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Contributions

All authors contributed to the study conception and design as well as material preparation, data collection and analysis. The first draft of the manuscript was written by AW and JA and all authors commented on previous versions of the manuscript. All authors have read and approve the final manuscript.

Corresponding author

Correspondence to Jesus D. Anampa.

Ethics declarations

Conflict of interest

All authors declare that they have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Montefiore Medical Center/Einstein College of Medicine approved this study.

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Appendix

Appendix

See Tables

Table 4 White Blood Cell Count Over Time in Black vs. Non-Black Cohorts
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Table 5 All Toxicities in Black vs. Non-Black Cohorts
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Table 6 Total number of infections by grade in black vs. non-black cohorts
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Table 7 Patients who required either dose reductions or dose delays
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Table 8 Univariate and Multivariable Analysis of PFS by Cox Regression Model
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See Figs. 

Fig. 3
figure 3

White blood cell count over time while on treatment with CDK4/6 inhibitors in Black vs. Non-Black patients. Abbreviations: C1D1: Cycle 1 Day 1; C1D14: Cycle 1 Day 14; C2D1: Cycle 2 Day 1; C2D14: Cycle 2 Day 14; C3D1: Cycle 3 Day 1; C4D1: Cycle 4 Day 1; C5D1: Cycle 5 Day 1; C6D1: Cycle 6 Day 1

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Fig. 4
figure 4

PFS compared between Black vs. Non-Black cohorts expressed in days. The yellow line represents the Non- Black cohort and the blue line represents the Black cohort. Abbreviations: PFS: Progression Free Survival

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Fig. 5
figure 5

PFS expressed in days in patients who experienced neutropenia while on CDK4/6 inhibitor treatment, compared between the Black vs Non-Black cohorts. The yellow line represents the Non-Black cohort and the blue line represents the Black cohort. PFS Progression Free Survival

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Fig. 6
figure 6

PFS expressed in days in patients who required a dose reduction while on treatment with CDK4/6 inhibitors, compared between the Black vs Non-Black cohorts. The yellow line represents the Non-Black cohort and the blue line represents the Black cohort PFS Progression Free Survival

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Fig. 7
figure 7

PFS expressed in days in patients on first line treatment with CDK4/6 inhibitors, compared between the Black vs. Non-Black cohorts. The yellow line represents the Non-Black cohort and the blue line represents the Black cohort. PFS Progression Free Survival

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Fig. 8
figure 8

PFS expressed in days in patients who did not experience neutropenia while on treatment with CDK4/6 inhibitors, compared in the Black vs. Non-Black cohorts. The yellow line represents the Non-Black cohort and the blue line represents the Black cohort. PFS Progression Free Survival

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Fig. 9
figure 9

PFS expressed in days in patients who did not require a dose reduction while on treatment with CDK4/6 inhibitors, compared in the Black vs. Non-Black cohorts. The yellow line represents the Non-Black cohort and the blue line represents the Black cohort. PFS Progression Free Survival

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9

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Schreier, A., Munoz-Arcos, L., Alvarez, A. et al. Racial disparities in neutrophil counts among patients with metastatic breast cancer during treatment with CDK4/6 inhibitors. Breast Cancer Res Treat 194, 337–351 (2022). https://doi.org/10.1007/s10549-022-06574-8

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  • DOI: https://doi.org/10.1007/s10549-022-06574-8

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