Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial

Yara Abdou; William E Barlow; Julie R Gralow; Funda Meric-Bernstam; Kathy S Albain; Daniel F Hayes; Nancy U Lin; Edith A Perez; Lori J Goldstein; Stephen K L Chia; Sukhbinder Dhesy-Thind; Priya Rastogi; Emilio Alba; Suzette Delaloge; Anne F Schott; Steven Shak; Priyanka Sharma; Danika L Lew; Jieling Miao; Joseph M Unger; Debasish Tripathy; Gabriel N Hortobagyi; Lajos Pusztai; Kevin Kalinsky

doi:10.1093/jnci/djae314

Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial

Yara Abdou
, William E Barlow
, Julie R Gralow
, Funda Meric-Bernstam
, Kathy S Albain
, Daniel F Hayes
, Nancy U Lin
, Edith A Perez
, Lori J Goldstein
, Stephen K L Chia
, Sukhbinder Dhesy-Thind
, Priya Rastogi
, Emilio Alba
, Suzette Delaloge
, Anne F Schott
, Steven Shak
, Priyanka Sharma
, Danika L Lew
, Jieling Miao
, Joseph M Unger

Debasish Tripathy, Gabriel N Hortobagyi, Lajos Pusztai, Kevin Kalinsky

University of North Carolina at Chapel Hill
SWOG Statistics and Data Management Center
American Society of Clinical Oncology
University of Texas MD Anderson Cancer Center
Loyola University Medical Center
University of Michigan
Dana-Farber Cancer Institute
Mayo Clinic Jacksonville
Fox Chase Cancer Center
BCCA-Vancouver Cancer Centre
McMaster University
University of Pittsburgh School of Medicine
Virgen de la Victoria University Hospitals of Málaga
Institut Gustave Roussy
Exact Sciences
University of Kansas
Yale University
Winship Cancer Institute of Emory University

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	889-897
Number of pages	9
Journal	Journal of the National Cancer Institute
Volume	117
Issue number	5
DOIs	https://doi.org/10.1093/jnci/djae314
State	Published - May 1 2025
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adult
Aged
Female
Humans
Middle Aged
Antineoplastic Agents, Hormonal/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Black or African American/statistics & numerical data
Breast Neoplasms/drug therapy
Disease-Free Survival
Hispanic or Latino/statistics & numerical data
Lymphatic Metastasis
Neoplasm Recurrence, Local
Racial Groups/statistics & numerical data
Receptor, ErbB-2/analysis
Receptors, Estrogen/analysis
Receptors, Progesterone/analysis
Treatment Outcome
White

Access to Document

10.1093/jnci/djae314

Cite this

Abdou, Y., Barlow, W. E., Gralow, J. R., Meric-Bernstam, F., Albain, K. S., Hayes, D. F., Lin, N. U., Perez, E. A., Goldstein, L. J., Chia, S. K. L., Dhesy-Thind, S., Rastogi, P., Alba, E., Delaloge, S., Schott, A. F., Shak, S., Sharma, P., Lew, D. L., Miao, J., ... Kalinsky, K. (2025). Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial. Journal of the National Cancer Institute, 117(5), 889-897. https://doi.org/10.1093/jnci/djae314

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title = "Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial",

abstract = "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.",

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author = "Yara Abdou and Barlow, \{William E\} and Gralow, \{Julie R\} and Funda Meric-Bernstam and Albain, \{Kathy S\} and Hayes, \{Daniel F\} and Lin, \{Nancy U\} and Perez, \{Edith A\} and Goldstein, \{Lori J\} and Chia, \{Stephen K L\} and Sukhbinder Dhesy-Thind and Priya Rastogi and Emilio Alba and Suzette Delaloge and Schott, \{Anne F\} and Steven Shak and Priyanka Sharma and Lew, \{Danika L\} and Jieling Miao and Unger, \{Joseph M\} and Debasish Tripathy and Hortobagyi, \{Gabriel N\} and Lajos Pusztai and Kevin Kalinsky",

year = "2025",

month = may,

day = "1",

doi = "10.1093/jnci/djae314",

language = "English",

volume = "117",

pages = "889--897",

journal = "Journal of the National Cancer Institute",

issn = "0027-8874",

publisher = "Oxford University Press",

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Abdou, Y, Barlow, WE, Gralow, JR, Meric-Bernstam, F, Albain, KS, Hayes, DF, Lin, NU, Perez, EA, Goldstein, LJ, Chia, SKL, Dhesy-Thind, S, Rastogi, P, Alba, E, Delaloge, S, Schott, AF, Shak, S, Sharma, P, Lew, DL, Miao, J, Unger, JM, Tripathy, D, Hortobagyi, GN, Pusztai, L & Kalinsky, K 2025, 'Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial', Journal of the National Cancer Institute, vol. 117, no. 5, pp. 889-897. https://doi.org/10.1093/jnci/djae314

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

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 -

Race and clinical outcomes in hormone receptor-positive, HER2-negative, node-positive breast cancer in the randomized RxPONDER trial

Abstract

UN SDGs

Keywords

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