15: Impact of Race on Pathologic Complete Response with Neoadjuvant Chemo-Immunotherapy and Chemotherapy Alone for Early-Stage Triple-Negative Breast Cancer

Saturday, March 23, 2024

8:30am – 8:40am ET

Location: C101

Abstract Presenter(s)

Natalia Polidorio, MD, PhD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, New York, United States

Submitter(s)

Natalia Polidorio, MD, PhD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, New York, United States

Author(s)

Natalia Polidorio, MD, PhD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, New York, United States
Lauren M. Perry, MD, MAS

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
VS

Varadan Sevilimedu, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States
Giacomo Montagna, MD, MPH

Assistant Attending
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
New York, New York, United States
NA

Nour Abuhadra, MD

Breast Medicine Service, Division of Solid Tumor Oncology
Memorial Sloan Kettering Cancer Center, United States
Monica Morrow, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, New York, United States
SD

Stephanie Downs-Canner, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States
GP

George Plitas, MD

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure(s):

Natalia Polidorio, MD, PhD: No financial relationships to disclose

Giacomo Montagna, MD, MPH: No financial relationships to disclose

Introduction:

Pathologic complete response (pCR) rates to neoadjuvant chemotherapy (NAC) in patients with triple-negative breast cancer (TNBC) differ across racial groups, with lower rates for Black patients. The underrepresentation of minority populations in the KN522 trial prompted us to evaluate pCR rates by race in early-stage TNBC patients receiving neoadjuvant chemo-immunotherapy as compared to a pre-KN522 NAC cohort.

Methods: This single-institution retrospective analysis included two distinct consecutive patient groups with early-stage TNBC: (1) 280 patients treated with neoadjuvant chemo-immunotherapy (6/2021-1/2023); (2) 496 NAC patients, treated before the approval of neoadjuvant pembrolizumab (3/2010-9/2019). Patients were grouped by self-reported race as White, Black, Asian, and Other. Clinical variables and pCR by race were analyzed using univariate (UVA) and multivariable analysis (MVA).

Results:

Racial distribution for chemo-immunotherapy patients was: 17% Asian, 19% Black, 61% White, and 3% of Other races. In the NAC group, race distribution was 10%, 23%, 61%, and 6% for Asian, Black, White, and Other races, respectively. Clinicopathologic characteristics and pCR rates by race are shown in the table. Overall pCR rates were 36% for patients receiving NAC and 56% for those receiving chemo-immunotherapy. This increase in pCR rate was largely driven by increases in pCR rates for Black patients (29% to 57%) and Asian patients (24% to 60%), with less of a change observed for White (38% to 54%) and no change for Other (63% to 63%) patients. On MVA, after adjusting for factors associated with pCR, such as age, tumor grade, lymphovascular invasion, and nodal disease, Asian patients treated with NAC were less likely to achieve pCR (OR 0.40, 95% CI 0.19-0.81, p = 0.013), and there was a non-significant decrease in pCR in Black patients (OR 0.69, 95% CI 0.42-1.12, p = 0.14). No statistical difference was observed in pCR by race for the chemo-immunotherapy group (p = 0.9), with similar rates between Asian, Black, and White patients (60%, 57%, and 54%, respectively).

Conclusions:

The differences in pCR rates by race in NAC patients were not seen in chemo-immunotherapy patients, with clinically relevant gains in pCR rates for Black and Asian patients. Research focusing on chemo-immunotherapy effects in minority racial groups may guide therapeutic approaches for populations most likely to derive benefit.

Learning Objectives:

Upon completion, participants will be able to describe and compare pathologic complete response rates by race to neoadjuvant chemotherapy and chemo-immunotherapy in patients with early-stage triple-negative breast cancer.
Upon completion, participants will be able to comprehend how the addition of chemo-immunotherapy increases rates of pathologic complete response in minority racial groups.
Upon completion, participants will be able to understand the importance of conducting research on chemo-immunotherapy in minority racial groups to guide therapeutic approaches for populations most likely to derive benefit.