Background: Neoadjuvant chemotherapy (NAC) is administered before surgery and expected to benefit certain breast cancer (BC) patients (pts). This study inspected outcomes of triple negative BC (TNBC), hormone receptor (HR) positive (+) HER2 negative (-), and HER2+ BC pts treated with NAC at John Peter Smith Hospital (JPS) in Tarrant County, TX. Methods: It is an IRB exempted retrospective review of JPS Oncology and Infusion Center’s registry data. Eligible pts were diagnosed with TNBC, HR+ HER2-, or HER2+ BC from 1/1/2016 to 12/31/2019 and underwent NAC. Age, race, NAC regimen, tumor grade, recurrence, and pt survival were collected from EPIC EMR. NCCN guidelines were used to standardize clinical prognostic and pathologic anatomic stages. Decrease in stage by at least one level was considered as improvement. Results: Refer to table for additional results. Total of 104 pts. 22 (21.2%) had recurrence, 14 (14.5%) had died. Using the full cox proportional hazard model, TNBC pts had a 3.214 times higher hazard of death/recurrence compared to other subsets (95% CI: 1.261, 8.193; p= 0.0145). 70 (67.3%) pts showed improvement in stage. 34 (32.7%) achieved pathological complete response (pCR). When compared to pts with residual disease, achieving pCR reduced hazard of death/recurrence by 71.6% (HR: 0.284; 95% CI: 0.095, 0.849; p= 0.0243). Conclusion: A clear unmet need is poor survival of Black TNBC pts. Safety net hospitals, like JPS, disproportionately treat Black pts. We show that attaining pCR correlates with improved survival, but less than a quarter of TNBC pts attained pCR. New NAC regimens with Pembrolizumab has become standard of care for TNBC pts since 2021 due to higher pCR rates. Still, there is a need for better NAC regimens to improve pCR in TNBC overall and clinical trials on new regimens should include Black pts. Also, more than a third of HR+ HER2- pts upstaged in LN after NAC. This suggests a need for pre-NAC radiology staging methods and better NAC regimen testing for this subset. TNBC(32 patients) HR+, HER2-(29 patients) HER2+(43 patients) TOTAL(104 patients, 103 women) Median Age Median Age 58 50 53 53 Racial Distribution of Patients Non-Hispanic White 9(28.1%) 11(37.9%) 11(25.6%) 31(29.8%) Black 18(56.3%) 12(41.4%) 15(34.9%) 45(43.3%) Hispanic 4(12.5%) 2(6.9%) 10(23.3%) 16(15.4%) Asian 1(3.1%) 4(13.8%) 7(16.3%) 12(11.5%) Clinical Prognostic Stage Before NAC and Surgery 1 1(3.1%) 0(0%) 9(20.9%) 10(9.6%) 2 8(25%) 13(44.8%) 20(46.5%) 30(28.8%) 3 22(68.8%) 16(55.2%) 14(32.6%) 52(50%) 4 1(3.1%) 0(0%) 0(0%) 1(0.9%) Pathologic Anatomic Stage After NAC and Surgery pCR 7(21.9%) 3(10.3%) 24(55.8%) 34(32.7%) 1 8(25%) 3(10.3%) 14(32.6%) 24(23.1%) 2 9(28.1%) 9(31%) 3(7%) 21(20.2%) 3 8(25%) 14(48.3%) 2(4.7%) 24(23.1%) 4 0(0%) 0(0%) 0(0%) 0(0%) Tumor Stage Difference Before/After Surgery Improvement 24(75%) 11(37.9%) 35(81.4%) 70(67.3%) Deterioration 1(3.1%) 7(24.1%) 0(0%) 8(7.7%) No Change 7(21.9%) 11(37.9%) 8(18.6%) 26(25%) Recurrence Recurrence 10(31.3%) 4(13.8%) 8(18.6%) 22(21.2%) Patients survived as of 9/19/2022 Survival 25(78.1%) 27(93.1%) 38(88.4%) 90(86.5%) Additional Significant Results Completion of NAC regimen 89 (85.6%) total pts Lymph Node (LN) Upstaging for HR+ HER2- 6 (20.7%) pts showed improvement in LN while 11 (37.9%) upstaged in LN pCR in Black TNBC pts Only 16% of Black pts achieved pCR Citation Format: Prakriti Srivastava, James-Michael Blackwell, Jolonda Bullock, Riyaz Basha, Kalyani Narra. Outcomes of patients treated with neoadjuvant chemotherapy for breast cancer at a safety net hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1940.
119 Background: The National Quality Forum endorsed initiation of adjuvant chemotherapy within 120 days of diagnosis for stage III colon cancer patients aged < 80 years. Nevertheless, no trials were conducted to establish this 120-day threshold and observational studies used to justify this threshold may be sensitive to recently identified sources of bias. Therefore, we aimed to assess the effect of initiating adjuvant chemotherapy within 120 days on survival among patients with stage III colon cancer. Methods: We used institutional registry data from the JPS Center for Cancer Care (JPS), an accredited Comprehensive Community Cancer Program. Eligible patients were adults aged < 80 years, diagnosed with first primary stage III colon cancer between 2011 and 2015, and received at least part of their first course treatment at JPS. Overall survival was defined as time from cancer diagnosis to death, loss to follow-up, or end of study. We emulated a pragmatic trial and estimated the intention to treat 36-month restricted mean survival difference and 95% confidence limits (CL) for initiating adjuvant chemotherapy within 120 days using a marginal structural model with stabilized inverse probability of treatment weights to reduce confounding bias. Results: Our study population comprised 62 patients, of whom 61% were aged 55 – 64 years, 58% were females, 61% were racial/ethnic minorities, 69% were uninsured, and 61% initiated adjuvant chemotherapy within 120 days after cancer diagnosis. The mean survival after 36 months of follow-up was 31 months (95% CL: 27, 34) for patients who initiated and 31 months (95% CL: 28, 34) for patients who did not initiate adjuvant chemotherapy within 120 days (mean survival difference = -0.10 months, 95% CL: -3.6, 3.4). Conclusions: Our results suggest no meaningful difference in overall survival between initiating or not initiating adjuvant treatment within 120 days of diagnosis for patients with stage III colon cancer, but our estimates are compatible with either a 3-month survival benefit or harm. A larger sample size may provide greater certainty whether the 120-day threshold is a questionable quality measure, as observed in our study.
Background: Lack of insurance has been identified as a key barrier to timely adjuvant chemotherapy, but this evidence may not be generalizable to public hospitals, where care is provided regardless of insurance status. Therefore, we aimed to assess whether insurance status is associated with delayed adjuvant chemotherapy among underserved women with stages I-III breast cancer treated at an urban public hospital. Methods: We used data from the JPS Center for Cancer Care institutional registry (accredited by the Commission on Cancer). This center is part of an urban public hospital network that serves Tarrant County, TX (population >2 million) and is a primary source of care for underserved individuals. Our eligible population included females aged ≥18 years diagnosed with stages I-III primary breast cancer between 2008 and 2015 and received surgery (lumpectomy or mastectomy) plus adjuvant chemotherapy as first course treatment. Treatment delay was defined as >120 days from diagnosis to adjuvant chemotherapy. We estimated risk ratios (RR), risk differences (RD), and corresponding 95% confidence limits (CL) for the association between insurance status and treatment delay, adjusting for age, race/ethnicity, marital status, and household income. Results: Our study population comprised 223 female breast cancer patients, of whom 55% were aged <55 years, 29% were non-Hispanic Black, 34% were Hispanic, 51% were uninsured, and 40% were publicly insured. The median time to adjuvant chemotherapy was 98 days (interquartile range: 83-119). Overall, 77% initiated adjuvant chemotherapy within 120 days after diagnosis. The initiation of adjuvant chemotherapy later than 120 days was 22% among publicly insured individuals and 25% among uninsured (RR=1.1; 95% CL: 0.63, 1.8; RD=0.06; 95% CL: -0.06, 0.17). Discussion: Our results suggest minimal differences in delayed adjuvant chemotherapy between publicly insured and uninsured breast cancer patients treated at an urban public hospital. More importantly, time to adjuvant chemotherapy in our population is only nominally longer than at National Comprehensive Cancer Network Institutions (93 days), which may be partially attributable to uninsured patients being enrolled in a hospital-based insurance assistance program. Future studies should assess whether hospital-based insurance assistance programs are similarly effective in other settings, which could have implications for reducing disparities in breast cancer outcomes. Citation Format: Bradford E. Jackson, Yan Lu, Jolonda Bullock, Muhammad Isa, Bassam Ghabach, Rohit P. Ojha. Insurance status and delayed adjuvant chemotherapy among women with breast cancer at an urban public hospital [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B080.
Background: The American Society of Clinical Oncologists/College of American Pathologists guidelines were updated in January 2020 to account for a range of positivity in Estrogen Receptor expression (ER), with samples with 1-10% immunoreactive tumor cell nuclei being reported as ER low positive (low+). There is limited data on endocrine responsiveness of this group and ER low+ cancers tend to profile and behave more like typical triple negative breast cancers (TNBC). The significance of isolated Progesterone Receptor (PR) expression is still unclear even though it is reported between 1-100%. This project investigated the number of ER low+ breast cancer patients at John Peter Smith Hospital (JPS). JPS has a higher proportion of Black breast cancer patients than SEER. As Black patients are more likely to have TNBC than non-Hispanic white patients (NHW), JPS also has a higher proportion of TNBC. With ER low+ cancers behaving more like TNBC, this research was conducted to see if there were also more ER low+ patients at JPS. Methods: A retrospective study was conducted using data from the institutional registry of the JPS Oncology and Infusion Center in Fort Worth, TX. Eligible patients were diagnosed with invasive breast cancer in 2020. Data from the JPS Department of Pathology and analyzed for ER and PR expression percentage, Her2 status, race, and ethnicity. HR+ was defined as either ER or PR being 10-100%. JPS data was compared to SEER data from 2014-2018. Results: JPS had 119 eligible patients for this study; 36 NHW, 31 Black, and 47 Hispanic. Of these, 6 were ER low+ and 4 of those were Her2-. 2 of the ER low+ patients were Black and 4 Hispanic. There were 96 Her2- patients, with 26 ER-, 4 ER low+, and 66 ER+. Of the overall 35 ER- patients, 34 were also PR- and 1 was PR low+. 4 of the 6 ER low+ were PR- and 2 PR low+. Conclusion: JPS has a higher percentage of ER low+ cases than previous studies conducted, with 2.6% and 1% found in literature review and 5% (95% CI: 1%, 9%) at JPS, but there is no national data to compare to yet. All the ER low+ patients at JPS were Black or Hispanic. This is limited by the number of ER low+ patients. Blacks and especially Hispanics were more likely to be ER- or ER low+ than NHW. They were also more likely to be PR-, with Black patients most likely to be PR low+. Black patients were most likely to be Her2-. For patients that were ER-, there was a strong concordance with PR status, with 1 case where PR was in a higher category and 86% of cases having ER and PR in agreement. Black and Hispanic patients account for 80% of TNBC at JPS. JPS has a significantly higher proportion of TNBC cases compared to SEER, with 21% (95% CI: 14%; 28%) of cases being TNBC and an additional 3.4% that are ER low+ and Her2-, therefore possibly behaving like TNBC. It is necessary to further investigate the significance of ER low+ and PR low+ expression, and for more research to be done on breast cancer in minority patients who are underrepresented in clinical trials but are more likely to have TNBC, which is aggressive and has poor survival rates. Percentage of Each Status by RaceER-ER low+ER+PR-PR low+PR+Her2-Her2+TNBCNon-Hispanic White22.2%(8)0%(0)77.8%(28)30.6%(11)5.6%(2)63.9%(23)77.8%(28)22.2%(8)20%(5)Black29%(9)6.5%(2)64.5%(20)41.9%(13)16.1%(5)41.9%(13)87.1%(27)9.7%(3)24%(6)Hispanic31.9%(15)8.5%(4)59.6%(28)51.1%(24)6.4%(3)42.6%(20)80.9%(38)19.1%(9)48%(12)Other50%(3)0%(0)33.3%(2)66.7% (4)0%(0)16.7%(1)66.7%(4)16.7% (1)8%(2)Overall29.4%(35)5%(6)64.7%(77)42.9%(51)8.4%(10)47.9 %(57)80.7%(96)17.6%(21)(25)*One patient was Black Hispanic and was included in both rows as ER+ PR- Her2- Comparison of Subtypes between JPS and SEERHR+ Her2-ER low+ PR- Her2-ER-PR low+ Her2 -HR-Her2- (TNBC)HR+ Her2+ER low+ PR- Her2+HR- Her2+UnknownJPS Cases by Subtype 202055.5% (66)3.4%(4)0.8%(1)21%(25)9.2%(11)1.7%(2)6.7%(8)1.7%(2)SEER Cases by Subtype 2014-201868%(included in HR+ Her2-)(included in HR+ Her2-)10%10%(included in HR+ Her2+)4%7% Citation Format: Callie Angell, Jolonda Bullock, Anna Diaz, Riyaz Basha, Kalyani Narra. Prevalence of low estrogen receptor and low progesterone receptor positivity at an urban safety net hospital [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 P3-14-16.
e19036 Background: The TNM classification system is the global standard for staging solid tumors, but the ability of TNM to differentiate prognostic groups may vary between settings because of differences in case-mix and treatments. Little information is available about prognostication using TNM in safety-net health systems, which provide care for socioeconomically disadvantaged individuals and have limited resources. Therefore, we aimed to assess the ability of TNM to differentiate prognostic groups for colorectal cancer patients in an urban safety-net cancer center. Methods: We used institutional registry data from the JPS Oncology and Infusion Center (Fort Worth, TX), which is a Comprehensive Community Cancer Program. Our eligible population included adults who were diagnosed with first primary colorectal cancer between 2008 and 2017, had TNM pathologic stage I – IV, and received at least part of the first course treatment at JPS. Our outcome of interest was 5-year all-cause mortality and our exposure of interest was TNM pathologic stage. Patients were followed from cancer diagnosis until death, loss to follow up, or end of study (December 31, 2018), whichever occurred first. We used a pseudo-observation approach and generalized linear models with log link to estimate risk ratios (RR) and corresponding 95% confidence limits (CL) comparing 5-year mortality between TNM stages, where stage I was the reference category. Results: Our eligible population comprised 655 colorectal cancer survivors, of whom 85% were aged < 65 years, 54% were male, 60% were racial/ethnic minorities, and 65% were uninsured at time of diagnosis. Stage IV patients had 4.4 times higher risk of 5-year mortality compared with stage I (RR = 4.4, 95% CL: 2.9, 6.6). Stage III patients had 2.1 times higher risk of 5-year mortality compared with stage I (RR = 2.1, 95% CL: 1.3, 3.2). Stage II patients had 1.4 times higher risk of 5-year mortality compared with stage I (RR = 1.4, 95% CL: 0.81, 2.3). Conclusions: Our findings suggest that TNM stages do not adequately differentiate colorectal cancer prognostic groups in a socioeconomically disadvantaged population. Stage IV is distinct, but stages I – III have limited differentiation and notable overlap. The use of TNM stages for colorectal cancer prognostication may be misleading for socioeconomically disadvantaged individuals. Factors beyond TNM should be considered for better prognostication in this population.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.