ASCO 2025 | Real-world racial disparities in outcomes with HER2-directed ADCs in mBC
Zunairah Shah, MD, Roswell Park Comprehensive Cancer Center, Buffalo, NY, discusses real-world survival outcomes in patients with HER2-positive metastatic breast cancer (mBC) treated with antibody-drug conjugates (ADCs). The study highlights significant racial and ethnic disparities, with Black patients having the worst outcomes. Although survival benefits were observed across groups, differences persisted even after adjusting for clinical variables. This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
So it’s the first study with a cohort of 7000 patients that evaluated the disparities within HER2 positive metastatic breast cancer with ADCs. We saw like we have a cohort of 7000 people and we stratified them into black, white, Hispanic and Asian and then we looked at their overall survivals. At five years the black patients had worse survival probability at 80%, Asians had the best at 89% followed by Hispanic at 86%...
So it’s the first study with a cohort of 7000 patients that evaluated the disparities within HER2 positive metastatic breast cancer with ADCs. We saw like we have a cohort of 7000 people and we stratified them into black, white, Hispanic and Asian and then we looked at their overall survivals. At five years the black patients had worse survival probability at 80%, Asians had the best at 89% followed by Hispanic at 86%. So overall the black patients even with antibody drug conjugates like T-DM1 and T-DXd are doing worse as compared to Asian and Hispanic patients and white patients. We stratified them again by T-DM1 and T-DXd. Black continues to have worse overall survival and it was statistically significant. The p-value was less than 0.05 across all racial groups. We adjusted for age, we adjusted for BMI, we adjusted for lines of treatment and we adjusted for lung comorbidities. Even after adjusting for all the covariates and all the confounders, we saw that the hazard ratio was 1.28 that was statistically significant. The cause of their worse overall survival could be multifactorial. It could be because of systemic bias it could be because of different tumor biology because in the original clinical trials that led to approval of T-DM1, T-DXd the number of black patients were less so we are we want to advocate for our clinical trials that have more inclusive enrollment and integration of real-world data for policy development.
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