TY - JOUR
T1 - Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial
AU - Abdou, Yara
AU - Barlow, William E
AU - Gralow, Julie R
AU - Meric-Bernstam, Funda
AU - Albain, Kathy S
AU - Hayes, Daniel F
AU - Lin, Nancy U
AU - Perez, Edith A
AU - Goldstein, Lori J
AU - Chia, Stephen K L
AU - Dhesy-Thind, Sukhbinder
AU - Rastogi, Priya
AU - Alba, Emilio
AU - Delaloge, Suzette
AU - Schott, Anne F
AU - Shak, Steven
AU - Sharma, Priyanka
AU - Lew, Danika L
AU - Miao, Jieling
AU - Unger, Joseph M
AU - Tripathy, Debasish
AU - Hortobagyi, Gabriel N
AU - Pusztai, Lajos
AU - Kalinsky, Kevin
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Oxford University Press. All rights reserved.
PY - 2025/5/1
Y1 - 2025/5/1
N2 - BACKGROUND: The phase III RxPONDER trial has affected treatment for node-positive (1-3), hormone receptor-positive, HER2-negative breast cancer with a 21-gene recurrence score (RS) less than 26. We investigated how these findings apply to different racial and ethnic groups within the trial.METHODS: The trial randomly assigned women to endocrine therapy (ET) or to chemotherapy plus ET. The primary clinical outcome was invasive disease-free survival (IDFS), with distant relapse-free survival (DRFS) as a secondary outcome. Multivariable Cox models were used to evaluate the association between race/ethnicity and survival outcomes, adjusting for clinicopathological characteristics, RS, and treatment.RESULTS: A total of 4048 women with self-reported race/ethnicity were included: Hispanic (15.1%), non-Hispanic Black (NHB) (6.1%), Native American/Pacific Islander (0.8%), Asian (8.0%), and non-Hispanic White (NHW) (70%). No differences in RS distribution, tumor size, or number of positive nodes were observed by race/ethnicity. Relative to NHWs, IDFS was worse for NHB participants (5-year IDFS 91.6% vs 87.1%, HR = 1.37; 95% CI = 1.03 to 1.81) and better for Asians (91.6% vs 93.9%, HR = 0.64; 95% CI = 0.46 to 0.91). Relative to NHW, DRFS was worse for NHB participants (5-year DRFS 95.8% vs 91.0%, HR = 1.65; 95% CI = 1.17 to 2.32) and better for Asians (95.8% vs 96.7%, HR = 0.59; 95% CI = 0.37 to 0.95). Adjusting for clinical characteristics, particularly body mass index, diminished the effect of race on outcomes. Chemotherapy treatment efficacy did not differ by race/ethnicity.CONCLUSIONS: NHB women had worse clinical outcomes compared with NHWs in the RxPONDER trial despite similar RS and comparable treatment. Our study emphasizes the persistent racial disparities in breast cancer outcomes while highlighting complex interactions among contributing factors.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01272037.
AB - BACKGROUND: The phase III RxPONDER trial has affected treatment for node-positive (1-3), hormone receptor-positive, HER2-negative breast cancer with a 21-gene recurrence score (RS) less than 26. We investigated how these findings apply to different racial and ethnic groups within the trial.METHODS: The trial randomly assigned women to endocrine therapy (ET) or to chemotherapy plus ET. The primary clinical outcome was invasive disease-free survival (IDFS), with distant relapse-free survival (DRFS) as a secondary outcome. Multivariable Cox models were used to evaluate the association between race/ethnicity and survival outcomes, adjusting for clinicopathological characteristics, RS, and treatment.RESULTS: A total of 4048 women with self-reported race/ethnicity were included: Hispanic (15.1%), non-Hispanic Black (NHB) (6.1%), Native American/Pacific Islander (0.8%), Asian (8.0%), and non-Hispanic White (NHW) (70%). No differences in RS distribution, tumor size, or number of positive nodes were observed by race/ethnicity. Relative to NHWs, IDFS was worse for NHB participants (5-year IDFS 91.6% vs 87.1%, HR = 1.37; 95% CI = 1.03 to 1.81) and better for Asians (91.6% vs 93.9%, HR = 0.64; 95% CI = 0.46 to 0.91). Relative to NHW, DRFS was worse for NHB participants (5-year DRFS 95.8% vs 91.0%, HR = 1.65; 95% CI = 1.17 to 2.32) and better for Asians (95.8% vs 96.7%, HR = 0.59; 95% CI = 0.37 to 0.95). Adjusting for clinical characteristics, particularly body mass index, diminished the effect of race on outcomes. Chemotherapy treatment efficacy did not differ by race/ethnicity.CONCLUSIONS: NHB women had worse clinical outcomes compared with NHWs in the RxPONDER trial despite similar RS and comparable treatment. Our study emphasizes the persistent racial disparities in breast cancer outcomes while highlighting complex interactions among contributing factors.TRIAL REGISTRATION: ClinicalTrials.gov: NCT01272037.
KW - Adult
KW - Aged
KW - Female
KW - Humans
KW - Middle Aged
KW - Antineoplastic Agents, Hormonal/therapeutic use
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Black or African American/statistics & numerical data
KW - Breast Neoplasms/drug therapy
KW - Disease-Free Survival
KW - Hispanic or Latino/statistics & numerical data
KW - Lymphatic Metastasis
KW - Neoplasm Recurrence, Local
KW - Racial Groups/statistics & numerical data
KW - Receptor, ErbB-2/analysis
KW - Receptors, Estrogen/analysis
KW - Receptors, Progesterone/analysis
KW - Treatment Outcome
KW - White
UR - https://www.scopus.com/pages/publications/105004647455
U2 - 10.1093/jnci/djae314
DO - 10.1093/jnci/djae314
M3 - Article
C2 - 39656951
SN - 0027-8874
VL - 117
SP - 889
EP - 897
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 5
ER -
