Race and Ethnicity Affect 21-Gene Recurrence Score, Overall Survival in Women with ER+ Breast Cancer

CHICAGO, Ill. — An observational cohort study out of Roswell Park Comprehensive Cancer Center demonstrates that race and ethnicity affect a woman’s 21-gene recurrence score, a tool used to determine risk of recurrence and distant metastasis in patients with early-stage, hormone-receptor-positive breast cancer. Based on the expression of 21 cancer-related genes detected in pre-treatment tumor specimens, recurrence score is used routinely in clinical care to identify patients who might benefit from chemotherapy as part of their treatment plan. Scores range from 0-100, with a score of 26 or higher indicating greater risk of recurrence and poorer overall survival.

Sung Jun Ma, MD, Resident in the Department of Radiation Medicine at Roswell Park, led the research team, which included investigators from Roswell Park, the University at Buffalo (UB) and the University of Florida. Their study, “Racial/ethnic differences in 21-gene recurrence score and survival among estrogen-receptor-positive breast cancer patients,” will be highlighted in a podium presentation at the American Society of Clinical Oncology (ASCO) Annual Meeting by first author Jasmin Gill, a sophomore at UB. Anurag Singh, MD, Director of Radiation Research and Co-Leader of the Cancer Stress Biology Program at Roswell Park, served as principal investigator.

“Increasing representation of racial and ethnic minorities is crucial to receiving detailed and specific results that indicate differences among populations,” says Gill. “With increased representation, we can further our understanding of prognostic tests such as the 21-gene recurrence score, with implications for further study and treatment of cancers in racial/ethnic minorities.”

“This study highlights the importance of considering the whole patient and their oncologic factors in decision-making,” says Dr. Singh. “Our findings suggest that race should be reported and considered in the analysis of trials and large databases.”

The study contradicts the secondary analyses of two previous studies that found no relationship between recurrence score (RS) and ethnicity: the Trial Assigning Individual Options for Treatment (TAILORx) and A Clinical Trial for Positive Node, Endocrine Responsive Breast Cancer (RxPONDER). Both evaluated the benefits of chemotherapy for patients with hormone-receptor-positive breast cancer who had an intermediate RS, between 11 and 25.

“African American women were underrepresented in those national clinical trials, and secondary analyses showed they have 21-gene recurrence scores comparable to others,” notes Dr. Ma. “However, our study using a nationwide oncology database suggested they were more likely to have more-aggressive breast cancer, as indicated by having higher recurrence score, and that among people with high recurrence score, there were no racial disparities in survival between African American and non-Hispanic white women.”

The Roswell Park-based team analyzed data from the National Cancer Database for 140,133 patients diagnosed between 2006-2018 with early-stage, estrogen-receptor-positive (ER+)  breast cancer. All underwent surgery followed by adjuvant endocrine therapy, and all had been assigned an RS. Patients were followed for a median of 66.2 months.

The study compared RS and overall survival in 115,651 non-white Hispanic women, 10,814 Hispanic women, 5,455 Black women and 5,455 Asian/Pacific Islander women. Data showed that compared with non-Hispanic white women, Black women were more likely to have a high RS (≥26) (p value=0.006), although their overall survival rate was on par with that of women in the other racial/ethnic groups who also had a high RS. However, compared with non-Hispanic white women, Black women with a lower RS (<26) tended to have poorer overall survival than Hispanic or Asian/Pacific Islander women who fell into that group. Asian/Pacific Islander women had longer overall survival regardless of their RS.

Presentation details

Racial/ethnic differences in 21-gene recurrence score and survival among estrogen receptor-positive breast cancer patients

• Abstract: 511, Breast Cancer Rapid Abstract Session
• Saturday, June 3, 4:42– 4:48 p.m. CDT in McCormick Place E451

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NOTE TO MEDIA: Annie Deck-Miller, Director of Public Relations, will be working in the onsite ASCO 23 press room. To coordinate coverage or arrange an interview with Roswell Park experts, please contact her at annie.deck-miller@roswellpark.org or 716-602-5817
 

From the world’s first chemotherapy research to the PSA prostate cancer biomarker, Roswell Park Comprehensive Cancer Center generates innovations that shape how cancer is detected, treated and prevented worldwide. Driven to eliminate cancer’s grip on humanity, the Roswell Park team of 4,000 makes compassionate, patient-centered cancer care and services accessible across New York State and beyond. Founded in 1898, Roswell Park was among the first three cancer centers nationwide to become a National Cancer Institute-designated comprehensive cancer center and is the only one to hold this designation in Upstate New York. To learn more about Roswell Park Comprehensive Cancer Center and the Roswell Park Care Network, visit www.roswellpark.org, call 1-800-ROSWELL (1-800-767-9355) or email ASKRoswell@RoswellPark.org.