Race and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Positive Breast Cancer in the Randomized RxPONDER Trial

Authors

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

Language

English

Publication Date

5-1-2025

Journal

Journal of the National Cancer Institute

DOI

10.1093/jnci/djae314

PMID

39656951

PMCID

PMC12058262

PubMedCentral® Posted Date

12-5-2024

PubMedCentral® Full Text Version

Post-print

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.

Keywords

Adult, Aged, Female, Humans, Middle Aged, Antineoplastic Agents, Hormonal, Antineoplastic Combined Chemotherapy Protocols, Black or African American, Breast Neoplasms, Disease-Free Survival, Hispanic or Latino, Lymphatic Metastasis, Neoplasm Recurrence, Local, Racial Groups, Erb-b2 Receptor Tyrosine Kinases, Receptors, Estrogen, Receptors, Progesterone, Treatment Outcome, White

Comments

Trial registration: ClinicalTrials.gov: NCT01272037.

Published Open-Access

yes

Recommended Citation

Abdou, Yara; Barlow, William E; Gralow, Julie R; et al., "Race and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Positive Breast Cancer in the Randomized RxPONDER Trial" (2025). Faculty, Staff and Student Publications. 6264.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6264