Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial

Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer. Cox proportional hazards models were used to evaluate associations between surgical procedure (BCS vs mastectomy) and LRFS adjusted for age, tumor receptor subtype, clinical T category, clinical nodal status, and residual cancer burden (RCB). In 1462 patients, surgical procedure was not associated with LRR or LRFS on either univariate or multivariate analysis. The unadjusted incidence of LRR was 5.4% after BCS and 7.0% after mastectomy, at a median follow-up time of 3.5 years. The strongest predictor of LRR was RCB class, with each increasing RCB class having a significantly higher hazard ratio for LRR compared with RCB 0 on multivariate analysis. Triple-negative receptor subtype was also associated with an increased risk of LRR (hazard ratio: 2.91, 95% CI: 1.8-4.6, P < 0.0001), regardless of the type of operation. In this large multi-institutional prospective trial of patients completing NAC, we found no increased risk of LRR or differences in LRFS after BCS compared with mastectomy. Tumor receptor subtype and extent of residual disease after NAC were significantly associated with recurrence. These data demonstrate that BCS can be an excellent surgical option after NAC for appropriately selected patients.

The impact of race and age on response to neoadjuvant therapy and long-term outcomes in Black and White women with early-stage breast cancer

PURPOSE

There are a paucity of data and a pressing need to evaluate response to neoadjuvant chemotherapy (NACT) and determine long-term outcomes in young Black women with early-stage breast cancer (EBC).

METHODS

We analyzed data from 2196 Black and White women with EBC treated at the University of Chicago over the last 2 decades. Patients were divided into groups based on race and age at diagnosis: Black women [Formula: see text] 40 years, White women [Formula: see text] 40 years, Black women [Formula: see text] 55 years, and White women [Formula: see text] 55 years. Pathological complete response rate (pCR) was analyzed using logistic regression. Overall survival (OS) and disease-free survival (DFS) were analyzed using Cox proportional hazard and piecewise Cox models.

RESULTS

Young Black women had the highest risk of recurrence, which was 22% higher than young White women (p = 0.434) and 76% higher than older Black women (p = 0.008). These age/racial differences in recurrence rates were not statistically significant after adjusting for subtype, stage, and grade. In terms of OS, older Black women had the worst outcome. In the 397 women receiving NACT, 47.5% of young White women achieved pCR, compared to 26.8% of young Black women (p = 0.012).

CONCLUSIONS

Black women with EBC had significantly worse outcomes compared to White women in our cohort study. There is an urgent need to understand the disparities in outcomes between Black and White breast cancer patients, particularly in young women where the disparity in outcome is the greatest.

The Impact of Race and Age on Response to Neoadjuvant Therapy and Long-Term Outcomes in Black and White Women with Early-Stage Breast Cancer

PURPOSE

There are a paucity of data and a pressing need to evaluate response to neoadjuvant chemotherapy (NACT) and determine long-term outcomes in young Black women with early-stage breast cancer (EBC).

METHODS

We analyzed data from 2,196 Black and White women with EBC treated at the University of Chicago over the last 2 decades. Patients were divided into groups based on race and age at diagnosis: Black women 40 years, White women 40 years, Black women 55 years, and White women 55 years. Pathological complete response rate (pCR) was analyzed using logistic regression. Overall survival (OS) and disease-free survival (DFS) were analyzed using Cox proportional hazard and piecewise Cox models.

RESULTS

Young Black women had the highest risk of recurrence, which was 22% higher than young White women (p=0.434) and 76% higher than older Black women (p=0.008). These age/racial differences in recurrence rates were not statistically significant after adjusting for subtype, stage, and grade. In terms of OS, older Black women had the worst outcome. In the 397 women receiving NACT, 47.5% of young White women achieved pCR, compared to 26.8% of young Black women (p=0.012).

CONCLUSIONS

Black women with EBC had significantly worse outcomes compared to White women in our cohort study. There is an urgent need to understand the disparities in outcomes between Black and White breast cancer patients, particularly in young women where the disparity in outcome is the greatest.

Demographic and Clinical Characteristics Associated With Familiarity, Interest, and Use of Integrative Therapies Among Patients With Breast Cancer

BACKGROUND

Integrative therapies reduce side effects from cancer treatment, though remain underutilized. There is a paucity of data on factors associated with familiarity, interest, and use of these therapies among breast cancer patients.

METHODS

A survey on familiarity, interest, and use of acupuncture, massage, meditation, music therapy, and yoga was conducted in patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort. Familiarity and interest were assessed using a five-point Likert scale, and modeled using proportional odds regression. Use was per self-report, modeled using logistic regression. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were calculated.

RESULTS

Of 1300 study participants, 59.6% were familiar with massage, 47.2% acupuncture, 46.9% meditation, 46.5% yoga, and 34.5% music therapy; 63.3% were interested in massage, 50.2% yoga, 47.9% meditation, 44.2% acupuncture, and 41.4% music therapy. Only 41.3% had used massage, 25.8% acupuncture, 18.7% yoga, 18.5% meditation, and 7.4% music therapy. Older age and lower education level were associated with lower familiarity and interest. Black patients were more likely than White patients to be interested. Patients' interest increased significantly when certain symptoms were treated. In the adjusted models, patients ages 40 to 65 were less likely than those ages <40 to have used massage (aOR 0.55, 95% CI: 0.31-0.98), yoga (aOR 0.52, 95% CI: 0.27-0.99), or meditation (aOR 0.47, 95% CI: 0.25-0.90). Patients with high school education were less likely than those with a graduate degree to have used acupuncture (aOR 0.42, 95% CI: 0.24-0.72), massage (aOR 0.39, 95% CI: 0.25-0.62), or meditation (aOR 0.26, 95% CI: 0.12-0.58). Having received chemotherapy was associated with increased interest in yoga (aOR 1.36, 95% CI: 1.07-1.73), massage (aOR 1.27, 95% CI: 1.01-1.59), or meditation (aOR 1.26, 95% CI: 1.01-1.57). Receipt of hormone therapy was not associated with interest or use.

CONCLUSION

In this racially diverse cohort of patients, familiarity and interest of integrative therapies were high, while use was low. Older age and lower education level were associated with lack of interest and use. Chemotherapy was associated with interest, but hormone therapy was not. Strategies to promote the benefits and use of integrative therapies among breast cancer patients are needed.

Racial differences in interest and use of integrative medicine among patients with breast cancer

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Background: Breast cancer treatment can be associated with side effects (SEs) that negatively impact quality of life. While some SEs can be treated with medications, such interventions come with additional SEs. Acupuncture, massage, meditation, music therapy and yoga have received ASCO endorsement for the management of therapy-related SEs. Many patients are interested in integrative services, but little is known about racial differences in interest and use of integrative services among patients with breast cancer. Methods: Breast cancer patients enrolled in the Chicago Multiethnic Epidemiologic Cohort study were sent a survey regarding their interest and use of five integrative services: acupuncture, massage, meditation, music therapy and yoga. Participants were asked how interested they would be in these services if offered, using a five-point Likert scale. Prior use was self-reported. Proportional odds were modeled for “interest” and binary logistic regression was modeled for “self-reported use.” Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated, controlling for age, education, marital status, household income, insurance, Carlson comorbidity index, molecular subtype and stage. Results: 1,300 patients responded to the survey, 928 White and 285 Black. Compared with White patients in this cohort, Black patients were less educated, had a lower household income, were more likely enrolled in Medicaid/Medicare, and had a greater Carlson comorbidity index. Over 97% of patients had stage 0-III breast cancer. While there was no difference in interest in acupuncture between Black and White patients (aOR 1.1, 95% CI 0.8-1.7), Black patients were significantly more interested in the use of massage (aOR 1.9, 95% CI 1.3-2.8), meditation (aOR 2.0, 95% CI 1.4-3.0), music therapy (aOR 2.7, 95% CI 1.8-4.0) and yoga (aOR 2.1, 95% CI 1.4-3.1). Black patients were significantly less likely than Whites to report acupuncture use (aOR 0.5, 95% CI 0.3-0.8); but there were no racial differences in self-reported use of massage (aOR 0.8, 95% CI 0.5-1.3), meditation (aOR 0.8, 95% CI 0.5-1.4), music therapy (aOR 1.7, 95% CI 0.8-3.3) and yoga (aOR 0.7, 95% CI 0.4-1.2). Conclusions: Black patients with breast cancer expressed more interest in integrative services than their White counterparts; there were no racial differences in self-reported use of integrative services except an increased use of acupuncture among White patients. A breast program focused on equity should provide access to these resources for all patients. Interest and self-reported use of integrative services among patients with breast cancer, by race. [Table: see text]

Updates in the Management of Relapsed and Refractory Acute Lymphoblastic Leukemia: An Urgent Plea for New Treatments Is Being Answered!

The treatment of acute lymphoblastic leukemia (ALL) has dramatically changed over the past three decades. However, relapsed and/or refractory ALL still remains with a very low survival and high morbidity associated with its treatment. Here, we will review the outstanding progress that has been made in the treatment of relapsed and/or refractory ALL and discuss future directions and challenges that require further investigation.

Personalizing Adjuvant Endocrine Therapy for Early-Stage Hormone Receptor-Positive Breast Cancer

Endocrine therapy has undergone major changes in the past few years, and is no longer a "one- size- fits- all" prescription. This article discussed some of the new developments and directions.

Abstract P3-14-15: The impact of race and age on response to neoadjuvant therapy and long-term outcomes in black and white women with early-stage breast cancer

Background: Women diagnosed with breast cancer under the age of 40 years (yrs) have a poorer prognosis as compared to older women. While black women overall have a slightly lower incidence of developing breast cancer than white women, black women are twice as likely to develop breast cancer under 40 yrs as compared to white women. There are a paucity of data and an urgent need to evaluate response to neoadjuvant chemotherapy (NACT) and determine long-term outcomes in young black women with breast cancer.. Methods: We analyzed data from 2,196 black and white patients (pts) with early-stage (stages 1-3) breast cancer treated at the University of Chicago over the last two decades. Pts were divided into four groups: white women &lt;= 40 yrs (young white, n=235), black women &lt;= 40 years (young black, n=151), White women &gt;= 55 years (older white, n=982), and black women &gt;= 55 years (older black, n=828). Overall survival (OS) and recurrence free survival (RFS) were determined using Cox proportional hazards models that controlled for stage, tumor grade, subtype, and Carlson comorbidity index. Risk of recurrence was examined using the method by Fine and Gray, accounting for competing risk from non-recurrence death. Pathologic complete response rate (pCR, ypT0/isN0) was determined with logistic regression controlling for subtype, stage, and tumor grade.. Results: The cohort members were followed for a median of 81 months. Of the four groups, young black pts had the highest risk of recurrence, which was 22% higher than young white pts (p=0.43) and 76% higher than older black pts (p=0.008). These age/racial differences in recurrence rates were not statistically significant after adjusting for subtype, stage, and grade. In terms of overall survival, older black patients had the worst outcome. After adjusting for stage, grade, subtype and comorbidities, increased mortality in older black vs older white pts persisted (adjusted hazard ratio: 1.55, 95% CI: 1.23-1.96, p&lt;0.001). In the 397 pts receiving NACT, 37.3% of young white pts achieved a pCR, compared to 11.9% of young black pts. In older white and black pts, 24.6% and 26.2% achieved a pCR, respectively. After adjusting for subtype, grade, and stage, young black pts were still less likely to achieve a pCR as compared to young white pts (adjusted odds ratio: 0.41, 95% CI: 0.19-0.88, p=0.022).. Conclusions: Black pts with early-stage breast cancer had poorer outcomes compared to white pts. In general, older pts had poorer OS compared with younger pts, with older black pts having the poorest OS. Young white pts had the highest pCR rates, while young black pts had the lowest. Future studies will work to elucidate the underlying reasons driving these disparities in clinical outcomes, which disproportionately affect black women.

Citation Format: Elizabeth Terman, Jori Sheade, Fangyuan Zhao, Frederick M. Howard, Nora Jaskowiak, Jennifer Tseng, Olwen Hahn, Gini Fleming, Olufunmilayo I. Olopade, Dezheng Huo, Rita Nanda. The impact of race and age on response to neoadjuvant therapy and long-term outcomes in black and white women with early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-15.

Provider-Level Barriers to Human Papillomavirus Vaccination in Survivors of Childhood and Young Adult Cancers

Purpose: We sought to understand clinician-level barriers to providing HPV vaccination to survivors of childhood and young adult cancers (CYACs). Methods: We conducted 30-minute qualitative interviews with primary care and specialty clinicians who care for survivors of CYACs at our academic medical center. Blinded reviewers analyzed transcripts and used an inductive approach to identify barriers to vaccination in this population. Results: We conducted 24 interviews (n = 11 primary care clinicians, n = 13 oncology clinicians). Thematic analysis revealed that primary care clinicians are universally viewed as holding ultimate responsibility for human papillomavirus (HPV) vaccination among survivors of CYACs. Both primary care and oncology clinicians believed vague, inconsistent HPV guidelines engendered uncertainty toward HPV vaccination's role and timing following completion of CYAC therapies. As such, compared with other vaccines, the HPV vaccination is not as consistently offered to survivors. Respondents identified direct guidance from oncologists to primary care clinicians and to patients as a potential strategy for improving HPV vaccination rates in this population. Finally, oncology clinicians frequently deprioritize the issue of preventing second, noniatrogenic cancers and consequently miss opportunities to discuss vaccination's merits with their patients. Conclusions: Despite not holding ultimate responsibility for vaccination, oncology clinicians have an opportunity to play an important role in ensuring access and overcoming hesitancy among survivors of CYACs. Developing clearer and more collaborative guidelines, helping to integrate vaccination into institutional electronic health record protocols, offering direct guidance to primary care colleagues, and participating in conversations with survivors of CYACs may help improve vaccination rates.