Expert Point of View: Virginia Kaklamani, MD, Lori J. Pierce, MD, FASTRO, FASCO, and Eric Winer, MD, FASCO
Press briefing moderator Virginia Kaklamani, MD, Professor of Medicine at UT Health San Antonio and leader of the Breast Cancer Program at UT Health San Antonio MD Anderson Cancer Center, said the findings from RxPONDER and those regarding the tumor microenvironment of metastasis (TMEM) doorway are complementary and were not presented “back to back by accident” at the San Antonio Breast Cancer Symposium (SABCS).
Virginia Kaklamani, MD
Lori J. Pierce, MD, FASTRO, FASCO
“We now have epidemiologic data from RxPONDER suggesting that estrogen receptor–positive patients who are Black have worse outcomes, and also now there is potentially a mechanistic reason for why this may be happening. We are starting to understand not just differences in biology between Blacks and Whites, but differences in the biology of cancer,” Dr. Kaklamani told journalists.
Nevertheless, invited discussant Lori J. Pierce, MD, FASTRO, FASCO, Professor of Radiation Oncology at the University of Michigan Rogel Cancer Center in Ann Arbor, commented: “Without a doubt, biology and ancestry are so very important, but we also have to dig deeper to understand and address the hidden factors of social determinants of health that contribute to disparities attributed to race. I think this is our collective responsibility.”
After the presentations, Eric Winer, MD, FASCO, Director of the Yale Cancer Center and President of ASCO, commented from the audience that the RxPONDER findings are among the most important that attendees would hear at the 2022 SABCS.
He elaborated in an interview with The ASCO Post: “Even in a trial setting where we are controlling for treatment, there is still this big impact of being Black. And the outcomes we see for Black women with breast cancer are simply not acceptable…. They suggest that it’s probably not about access to care, as all of the patients received identical treatment on the trial. We need to fully understand all of the contributors to the worse outcome.”
Eric Winer, MD, FASCO
As a possible biological explanation, he found the TMEM doorway findings interesting but emphasized that social determinants of health may underlie such biological impacts. “Assuming the TMEM is a good hypothesis, why do these differences [in TMEM doorway density] exist? Is it because of some genetic difference? Or because of an environmental or societal influence?” he asked.
“We have got to shine a big bright light on this issue,” Dr. Winer said, “because no matter what treatments we develop, if they are not going to be effective in Black women because of factors we don’t understand, the result will still be an excess number of deaths.”
DISCLOSURE: Dr. Kaklamani has served as a consultant to or a speaker for Puma, AstraZeneca, Daiichi Sankyo, Menarini, Gilead Sciences, Pfizer, Genentech, Exact Sciences, Novartis, and Seagen; and has received research support from Eisai. Dr. Pierce reported an unpaid consulting role with Exact Sciences. Dr. Winer reported no conflicts of interest.
Suboptimal treatment, which often underlies worse outcomes for cancer in racial minorities, did not explain a recent finding from the landmark RxPONDER study: non-Hispanic Black women with hormone receptor–positive, HER2-negative, lymph node–positive breast cancer had worse outcomes compared with...