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Racial Differences in Clinical Outcomes From Metastatic Breast Cancer: A Pooled Analysis of CALGB 9342 and 9840—Cancer and Leukemia Group B

Blase N. Polite, Constance Cirrincione, Gini F. Fleming, Donald A. Berry, Andrew Seidman, Hyman Muss, Larry Norton, Charles Shapiro, Kamal Bakri, Kelly Marcom, Diana Lake, Joel H. Schwartz, Clifford Hudis, Eric P. Winer

From the University of Chicago, Chicago, IL; Cancer and Leukemia Group B Statistical Center, Duke University Medical Center, Durham; University of North Carolina at Chapel Hill, Chapel Hill, NC; Memorial Sloan-Kettering Cancer Center, New York, NY; Vermont Cancer Center, Burlington, VT; The Ohio State University Medical Center, Columbus, OH; and the Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Blase N. Polite, MD, MPP, The University of Chicago Medical Center, 5841 South Maryland Ave, MC 2115, Chicago, IL 60637-1470; email: bpolite{at}medicine.bsd.uchicago.edu

Purpose: African American women are more likely to be diagnosed with metastatic breast cancer at the time of presentation than whites, and have shorter survival once diagnosed. This study examines racial differences in clinical outcomes in the setting of two large cooperative group randomized clinical trials.

Patients and Methods: The study cohort consisted of 787 white (80%) and 195 African American (20%) patients with metastatic breast cancer enrolled in two successive Cancer and Leukemia Group B (CALGB) trials using taxanes in the metastatic setting. Differences in overall survival (OS), response incidence, and time to treatment failure (TTF) were examined by race. In addition, differences in the incidence of baseline and treatment-related toxicities were examined.

Results: With 779 deaths (166 African Americans and 613 whites), median OS was 14.3 months for African Americans and 18.75 months for whites (hazard ratio [HR] = 1.37; 95% CI, 1.15 to 1.63). When adjusted for prognostic factors, African Americans had a 24% increase in the hazard of death compared with whites (HR = 1.24; 95% CI, 1.02 to 1.51). No significant differences in TTF or overall response to therapy were seen. No clinically significant toxicity differences were seen.

Conclusion: African Americans with metastatic breast cancer have an increased hazard of death compared with whites despite the receipt of similar per-protocol treatment, but experience no differences in TTF or overall response to therapy. We hypothesize that more direct and robust measures of comorbidities, and perhaps other factors such as receipt of subsequent therapy could help further explain the observed survival difference.

Supported by National Cancer Institute Grants No. CA41287, CA33601, CA77651, CA77406, CA77658, CA47559, CA47577, and CA32291, and by Aventis through the Cancer and Leukemia Group B Foundation (B.N.P.).

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.