Racial Disparities in Clinical Outcomes on Investigator-Initiated Breast Cancer Clinical Trials at an Urban Medical Center.

BACKGROUND: Black women are 40% more likely to die of breast cancer compared to White women. Inadequate representation of Black patients in clinical trials may contribute to health care inequity. We aimed to assess breast cancer clinical outcomes in Non-Hispanic Black (Black) versus Non-Hispanic White (White) women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials at Winship Cancer Institute at Emory University, given the significant number of patients from underrepresented minority groups seen at Winship. MATERIALS AND METHODS: Black and White women with MBC on investigator-initiated trials at Emory between 2009 and 2019 were retrospectively evaluated. Univariate analyses and multiple logistic regression models were used to assess clinical response and treatment toxicities. Differences in overall survival between groups was assessed using quantile analysis. RESULTS: Sixty-two women with MBC were included (66% White vs. 34% Black). Black patients had less clinical benefit from the trial therapy as only 57% had partial response or stable disease as best response compared to 78% of White women (P = .09). Quantile analysis showed significant difference in mean survival between Whites and Blacks by the end of follow up (64 vs. 38 months). There were no significant differences in toxicities between groups. CONCLUSION: Participation rates of Black women with MBC on investigator-initiated clinical trials at an urban cancer center were higher compared to key national trials. Black women had worse treatment response and survival. These results reinforce the need for assessment of tumor differences by ancestry and continued improvement in minority representation on clinical trials.

Impact of race and ethnicity on presentation and outcomes of patients treated on rhabdomyosarcoma clinical trials: A report from the Children's Oncology Group.

BACKGROUND: Racial and ethnic disparities have been demonstrated in pediatric and adult cancers. However, there is no consensus on whether such disparities exist in the presentation, treatment, and outcome of patients with rhabdomyosarcoma (RMS). METHODS: Patient information from the seven most recent RMS clinical trials was obtained from the Children's Oncology Group (COG). Chi-squared analyses were used to compare patient, tumor, and treatment characteristics across racial and ethnic groups. Pairwise analyses comparing Non-Hispanic Black (NHB) versus Non-Hispanic White (NHW) racial groups and Hispanic versus NHW ethnic groups were conducted for significant characteristics. Kaplan-Meier method and Wilcoxon signed-rank tests were performed to analyze outcomes. RESULTS: In the overall cohort (n = 2157), patients' self-identified race/ethnicity was: 0.4% American Indian/Alaska Native, 2.6% Asian, 12.6% Hispanic, 0.2% Native American/other Pacific Islander, 12.8% NHB, 61.9% NHW, and 9.6% unknown. Six characteristics differed by race/ethnicity: age, histology, IRS group, invasiveness, metastatic disease, and FOXO1 fusion partner. Five were significant in pairwise comparisons: NHB patients were more likely to present at age ≥ 10 years and with invasive tumors than NHW patients; Hispanic patients were more likely to present with alveolar histology, metastatic disease, and IRS group IV disease than NHW patients. No differences were found in event free or overall survival of the entire cohort, in risk group-based subset analyses, or among patients with high-risk characteristics significant on pairwise analysis. CONCLUSIONS: While NHB and Hispanic patients enrolled in COG trials presented with higher risk features than NHW patients, there were no outcome differences by racial or ethnic group.

Smoking Mechanics and Impact on Smoking Cessation: Two Cases of Smoking Lapse Status Post Lung Transplantation.

BACKGROUND: Smoking behavior includes mechanisms taken on by persons to adjust for certain characteristic changes of cigarettes. However, as lung function declines due to lung-specific diseases, it is unclear how mechanical smoking behavior changes affect persons who smoke. We review two cases of patients who stopped smoking prior to and then subsequently resumed smoking after lung transplantation. METHODS: A retrospective review of two patients who were recipients of lung transplantation and sustained from cigarette usage prior to transplantation. RESULTS: Patient A was a 54-year-old woman who received a double lung transplant secondary to chronic obstructive pulmonary disease (COPD) in October 2017. She had stopped smoking cigarettes in July 2015 (FEV1 .56 L). Patient B was a 40-year-old man who received a double lung transplantation due to sarcoidosis in January 2015. He stopped smoking cigarettes in February 2012 (FEV1 1.15 L). Post-transplant, Patient A resumed smoking on March 2018 where her FEV1 was at 2.12 L (5 months post-transplantation), and Patient B resumed smoking in April 2017 where his FEV1 was 2.37 L (26 months post-transplantation). CONCLUSION: We report on two patients who resumed smoking after lung transplantation. While variations of smoking mechanics have been identified as a function of nicotine yield and type of cigarette, it lung mechanics may play a role in active smoking as well. Therefore, proper screening for tobacco usage post-lung transplantation should be considered a priority in order to preserve transplanted lungs.