Brigid K. Killelea

Abstract P1-09-01: African American women have lower pathologic complete response rates to neoadjuvant chemotherapy compared to white women for triple negative and HER 2 positive breast cancer

Introduction Although racial disparities in breast cancer treatment have been well documented, data regarding differences in response to neoadjuvant chemotherapy are few. In 2010 the National Cancer Database (NCDB) included a new variable, documenting pathologic complete response (pCR) after neoadjuvant chemotherapy. The purpose of this study was to explore racial differences in the rates of pCR by molecular subtype. Methods The NCDB was queried to identify women diagnosed with invasive, stage 1-3 breast cancer in 2010 -2011 who received neoadjuvant chemotherapy. Univariate and multivariate logistic regression was performed to determine factors associated with likelihood of pCR. Results Out of 278,815 patients with known race and ethnicity, 27,300 (10%) received neoadjuvant chemotherapy. Of 17,970 where the outcome was known, 5,944 (33%) had a pCR. As seen in the table, there were no differences in response rate for ER/PR+ tumors, but compared to whites, non-hispanic black women had a lower rate of pCR for ER/PR- Her2+ and triple negative tumors. This difference persisted when adjusted for patient age, clinical T stage, clinical N stage, histology, grade, comorbidity index, facility type, geographic region, insurance status, and census-derived median income and education for the patient9s zip code (OR 0.84, 95% CI: 0.77-0.93). Conclusions Non-hispanic black women have a lower likelihood of pCR after neoadjuvant chemotherapy compared to white women for triple negative and Her 2 positive breast cancer. It is unknown whether this is due to biologic differences in chemosensitivity or whether it represents treatment or socioeconomic differences that cannot be adjusted for in the current analysis. Citation Format: Killelea BK, Chagpar AB, Horowitz NR, Pusztai L, Wang S, Mougalian S, Lannin DR. African American women have lower pathologic complete response rates to neoadjuvant chemotherapy compared to white women for triple negative and HER 2 positive breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-01.

Abstract P3-14-02: Patterns of the use of primary systemic therapy in the United States

Background: Primary systemic therapy (PST) is an accepted alternative to adjuvant systemic therapy of breast cancer. It provides equivalent survival, increased breast conservation rates, and prognostic information. Methods: This analysis assesses patterns of PST use based on information collected by the National Cancer Database (NCDB), a joint project of the American College of Surgeons and the American Cancer Society which captures data on over 70% of all diagnosed breast cancer patients in the U.S. Using the b-participant use file of the NCDB, we evaluated regional, patient, and tumor factors associated with PST use. Results: The NCDB captured 621,319 patients treated with PST from 2006 to 2010. Of these, 7.4% received systemic therapy pre-operatively, and 3.6% in both the pre- and post-operative settings. Factors correlating with timing of therapy are shown in the table. PST use increased steadily from 7.0% to 7.8% (p<0.001) from 2006 to 2010. PST was significantly more frequently used in younger, African-American, Hispanic, low-income, uninsured patients with larger, node positive tumors, living in large metropolitan areas in the West and treated in academic centers. These factors remained significantly and independently associated with PST on multivariate analysis. View this table: Conclusion: PST appears to be underutilized, received by only 7.8% of all patients, 36% of T3-T4 tumors, and 26.0% of clinically node positive patients. However, its rate of use has increased over the past years. There is also significant regional variation in the use of PST, independent of patient and tumor factors. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-02.

Surgical and oncologic outcomes in patients with breast cancer undergoing tattooing prior to neoadjuvant chemotherapy.

100 Background: Neoadjuvant chemotherapy for breast cancer increases the breast preservation rate, but also increases the rate of local recurrence, probably because there is no standard technique to determine the amount of breast tissue to be removed. In 2007 we described a technique where the surgeon maps the extent of a breast tumor, plans a surgical incision, and tattoos the breast prior to the patient receiving neoadjuvant chemotherapy. After the chemotherapy, digital photographs are retrieved that allow the surgeon to precisely reconstruct where the margins of the original tumor were in the breast, and to proceed with a planned operation to remove the entire tumor bed but minimal surrounding breast tissue. The purpose of this study is to describe a series of patients treated with this technique and to evaluate the surgical and oncologic outcomes obtained.nnnMETHODSnData were collected from a prospective breast cancer database and from chart review on all patients treated with this technique at a single institution. Most patients receiving neoadjuvant chemotherapy underwent the tattooing, unless they knew beforehand that they were going to undergo a mastectomy.nnnRESULTSnBetween June 2005 and January 2011, 87 patients underwent breast tattooing followed by chemotherapy. Of patients who have completed subsequent definitive therapy, the initial surgery was mastectomy in 31 and lumpectomy in 53. Most patients tumors became nonpalpable following the therapy, and the pathologic complete and partial response rates were 22% and 64% respectively. Of patients who underwent an initial lumpectomy, 5/53 (9%) had positive margins and underwent further surgery (2 mastectomy and 3 wider lumpectomy). With a median follow-up of 36 months, only 1 patient has had an in-breast local recurrence.nnnCONCLUSIONSnThese early results clearly show a lower rate of re-excision and a lower rate of local recurrence than commonly reported in the literature for breast preservation following neoadjuvant chemotherapy. The technique warrants wider application and further study.