Racial disparities in treatment patterns and clinical outcomes in patients with HER2-positive metastatic breast cancer

Abstract

Data characterizing demographics, treatment patterns, and clinical outcomes in black patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) are limited. registHER is a large, observational cohort study of patients (n = 1,001) with HER2-positive MBC diagnosed ≤6 months of enrollment and followed until death, disenrollment, or June 2009 (median follow-up of 27 months). Demographics, treatment patterns, and clinical outcomes were described for black (n = 126) and white patients (n = 793). Progression-free survival (PFS) following first-line therapy and overall survival (OS) were examined. Multivariate analyses adjusted for baseline and treatment factors. Black patients were more likely than white patients to be obese (body mass index ≥30), to have diabetes, and to have a history of cardiovascular disease; they were also less likely to have estrogen receptor or progesterone receptor positive disease. In patients treated with trastuzumab, the incidence of cardiac safety events (grade ≥3) was higher in black patients (10.9 %) than in white patients (7.9 %). Unadjusted median OS and PFS (months) were significantly lower in black patients than in white patients (OS: black: 27.1, 95 % confidence interval [CI] 21.3-32.1; white: 37.3, 95 % CI 34.6-41.1; PFS: black: 7.0, 95 % CI 5.7-8.2; white: 10.2, 95 % CI 9.3-11.2). The adjusted OS hazard ratio (HR) for black patients compared with white patients was 1.29 (95 % CI 1.00-1.65); adjusted PFS HR was 1.29 (95 % CI 1.05-1.59). This real-world evaluation of a large cohort of patients with HER2-positive MBC shows poorer prognostic factors and independently worse clinical outcomes in black versus white patients. Further research is needed to identify potential biologic differences that could have predictive impact for black patients or that could explain these differences.

Fig. 1

Select clinical characteristics in black and white patients at the time of metastatic breast cancer diagnosis. BMI body mass index, CVD cardiovascular disease, ER estrogen receptor, PR progesterone receptor

Fig. 2

Kaplan–Meier plots showing first-line a PFS and b OS since diagnosis of metastatic breast cancer in black and white patients. CI confidence interval, HR hazard ratio, OS overall survival, PFS progression-free survival

Fig. 3

Analysis of progression-free survival (PFS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor

Fig. 4

Analysis of overall survival (OS) by baseline characteristics and treatment patterns in black and white patients. BMI body mass index, CI confidence interval, CNS central nervous system, CVD cardiovascular, ER estrogen receptor, HR hazard ratio, met metastases, PR progesterone receptor