Abstract P3-01-02: Impact of race, socioeconomic status and clinicopathological features on clinical outcomes in triple negative breast cancer in the ECOG-ACRIN EA1131 trial

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Abstract Background: Racial disparities in breast cancer outcomes persist despite a decline in overall breast cancer mortality. Black women have a higher incidence of triple negative breast cancer (TNBC), worse social determinants of health (SDOH), and quality of cancer care, which contributes to racial survival disparities. The EA1131 study evaluated patients with clinical stage II-III TNBC with residual disease after completion of neoadjuvant chemotherapy to determine whether invasive disease-free survival (IDFS) would be improved with adjuvant platinum compared with capecitabine. Herein we report a post hoc analysis of EA1131 to evaluate whether racial disparities were observed among patients with residual TNBC. Methods: Our study population included Black and White patients in EA1131. Race was self-reported; participants who identified as part of a racial group with <15 patients or unknown race were excluded from this analysis (n=39). Our primary objective was to evaluate clinicopathological features, basal-subtype, SDOH, and survival outcomes by race in EA1131. The Agency for Healthcare Research Quality (AHRQ) neighborhood socioeconomic index (nSES) was calculated using residential zip codes linked to county level data on occupation, income, poverty, wealth, education, and crowding. Binary and categorical data were analyzed with Fisher’s exact test to evaluate differences in baseline characteristics by race. Cox regression analysis was used to estimate hazard ratios for DFS and overall survival (OS), adjusting for treatment arm, intrinsic subtype (basal vs non-basal), tumor grade, clinical stage prior to neoadjuvant treatment, pathologic stage after neoadjuvant treatment at the time of surgery, BMI, nSES index, and insurance type. Results: Of 415 patients enrolled in EA1131, 376 were included in this analysis (308 White [82%] and 68 Black [18%]). Most patients had basal-subtype TNBC (77%), grade 3 disease (71%), pathologic stage II disease (49%), private insurance (70%), and a BMI ≥30 (49%). There were no racial differences in grade, clinical or pathological stage. Black patients were more likely to have basal-subtype TNBC (89% vs 75%; p=0.009) and a BMI ≥30 (62% vs 46%; p=0.026) compared to White patients. Black patients were more likely to be in the lowest nSES index quartile (39% vs 22%; p=0.008) and have Medicaid (32% vs 13%; p<0.001), while White patients were significantly more likely to have private insurance (73% vs 57%; p=0.013). The median DFS for White patients was 42.6 months compared to 25.1 months for Black patients, but this numerical difference was not statistically significant (p=0.24). There were also no significant differences in DFS or OS by race (HR 1.03, 95% CI: 0.65-1.61 and HR 0.67, 95% CI: 0.36-1.22, respectively), after adjusting for potential confounders. Conclusion: Black patients with residual TNBC enrolled on EA1131 were more likely to have more aggressive basal-subtype tumors, to be obese, and to have lower socioeconomic status. Despite these factors, no significant differences in survival by race were observed. While this analysis was limited due to sample size, one possibility is that enrollment in a clinical trial, by minimizing differences in treatment received, has the potential to mitigate racial inequities in care. Larger studies are necessary to confirm these findings. Citation Format: Moriah Forster, Fengmin Zhao, Sarah Bell, Ingrid A. Mayer, Carlos L. Arteaga, William F. Symmans, Ben H. Park, Brian L. Burnette, Amye J. Tevaarwerk, Sofia F. Garcia, Karen L. Smith, Della F. Makower, Margaret Block, Kimberly A. Morley, Chirag R. Jani, Craig Mescher, Shabana J. Dewani, Bernard Tawfik, Lisa E. Flaum, Erica L. Mayer, William M. Sikov, Eve T. Rodler, Lynne I. Wagner, Angela M. DeMichele, Joseph A. Sparano, Ruth C. Carlos, Antonio C. Wolff, Kathy D. Miller, Sonya Reid. Impact of race, socioeconomic status and clinicopathological features on clinical outcomes in triple negative breast cancer in the ECOG-ACRIN EA1131 trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P3-01-02.

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