non-AA Patients Research Articles

Use of prasugrel and clinical outcomes in African‐American patients treated with percutaneous coronary intervention for acute coronary syndromes

To investigate the use of prasugrel after percutaneous coronary intervention (PCI) in African American (AA) patients presenting with acute coronary syndrome (ACS). AA patients are at higher risk for adverse cardiovascular outcomes after PCI and may derive greater benefit from the use of potent antiplatelet therapy. Using the multicenter PROMETHEUS observational registry of ACS patients treated with PCI, we grouped patients by self-reported AA or other races. Clinical outcomes at 90-day and 1-year included non-fatal myocardial infarction (MI), major adverse cardiac events (composite of death, MI, stroke, or unplanned revascularization) and major bleeding. The study population included 2,125 (11%) AA and 17,707 (89%) non-AA patients. AA patients were younger, more often female (46% vs. 30%) with a higher prevalence of diabetes mellitus, chronic kidney disease, and prior coronary intervention than non-AA patients. Although AA patients more often presented with troponin (+) ACS, prasugrel use was much less common in AA vs. non-AA (11.9% vs. 21.4%, respectively, P = 0.001). In addition, the use of prasugrel increased with the severity of presentation in non-AA but not in AA patients. Multivariable logistic regression showed AA race was an independent predictor of reduced use of prasugrel (0.42 [0.37-0.49], P < 0.0001). AA race was independently associated with a significantly higher risk of MI at 90-days and 1 year after PCI. Despite higher risk clinical presentation and worse 1-year ischemic outcomes, AA race was an independent predictor of lower prasugrel prescription in a contemporary population of ACS patients undergoing PCI.

Comparison of the Prognostic Utility of the Cell Cycle Progression Score for Predicting Clinical Outcomes in African American and Non-African American Men with Localized Prostate Cancer

BackgroundBetter prostate cancer risk stratification is necessary to inform medical management, especially for African American (AA) men, for whom outcomes are particularly uncertain. ObjectiveTo evaluate the utility of both a cell cycle progression (CCP) score and a clinical cell-cycle risk (CCR) score to predict clinical outcomes in a large cohort of men with prostate cancer highly enriched in an AA patient population. Design, setting, and participantsPatients were diagnosed with clinically localized adenocarcinoma of the prostate and treated at The Ochsner Clinic (New Orleans, LA, USA) from January 2006 to December 2011. CCP scores were derived from archival formalin-fixed, paraffin-embedded biopsy tissue. CCR scores were calculated as the combination of molecular (CCP score) and clinical (Cancer of the Prostate Risk Assessment [CAPRA] score) components. InterventionActive treatment (radical prostatectomy, radiation therapy alone, or radiation and hormone therapy) or watchful waiting. Outcome measurements and statistical analysisThe primary outcome was progression to metastatic disease. Association with outcomes was evaluated via Cox proportional hazards survival analysis and likelihood ratio tests. Results and limitationsThe final cohort included 767 men, of whom 281 (36.6%) were AA. After accounting for ancestry, treatment, and CAPRA in multivariable analysis, the CCP score remained a significant predictor of metastatic disease (hazard ratio [HR] 2.04; p<0.001), and there was no interaction with ancestry (p=0.20) or treatment (p=0.09). The CCR score was highly prognostic (HR 3.86; p<0.001), and as with the CCP score, there was no interaction with ancestry (p=0.24) or treatment (p=0.32). Limitations include the retrospective study design and the use of self-reported ancestry information. ConclusionsA CCR score provided significant prognostic information regardless of ancestry. The findings demonstrate that AA men in this study cohort appear to have similar prostate cancer outcomes to non-AA patients after accounting for all available molecular and clinicopathologic variables. Patient summaryIn this study we evaluated the ability of a combined molecular and clinical score to predict the progression of localized prostate cancer. We found that the combined molecular and clinical score predicted progression to metastasis regardless of patient ancestry or treatment. This suggests that the combined molecular and clinical score may be a valuable tool for determining the risk of metastasis in men with newly diagnosed prostate cancer in order to make appropriate treatment decisions.

Gender-Based Differences in the Epidemiology of Inflammatory Bowel Disease in a Predominantly African American Population

Introduction: Although Inflammatory Bowel Disease (IBD) is increasing in African American (AA) population, there is a sparsity of information on the epidemiological features of IBD in AA. Since there is a large AA population in our inner-city clinic, we did a study to compare our AA IBD patients to Non-AA patients. Methods: In order to establish a database of IBD patients seen in the GI clinic of a urban medical center, we used ICD-9 codes to identify all patients with a visit between 2011 and 2014 (n= 409). We identified three categories of patients (definitely not IBD (n=233), possibly IBD (n=68) and endoscopically positive IBD (n=109). We required that patients have two visits, one prior to 2015 and one on or after 2015 (n= 97). Data included demographics, endoscopic/histologic findings, details of treatment, and possible measurements to assess disease control. Data was analyzed using JMP 13 software. Results: Of the total 97 patients, 60 had Crohn's disease (CD); 37 had Ulcerative Colitis (UC), most of the patients were AA (75.5 %). There were more females than males for both CD (62 %) and UC(70%). When assessed based on race and disease AA Females were more likely than Non-AA to be represented in the disease class (UC (AAF= 67% vs Non-AAF =42% p=0.008) and CD (AAF=84% vs Non-AAF= 42% p=0.11). Overall, females were diagnosed later than males (mean age - 32.25 vs. 29.97) but it was not statistically significant. CD were more likely to have severe disease at first visit, defined by elevated C-reactive Protein (CRP) than UC (19 vs 6 mg per liter). AA had more active disease at first visit as defined by higher CRP in both CD and UC (CD AA=20 vs Non-AA=11; UC AA= 6.7 vs Non-AA =3.6). Patients with CD were more likely to be on a biologic (42% vs 16% p=0.009) and on combination therapy (63% vs 27% p=0.005). There were no significant differences between either race or gender with respect to treatment. Conclusion: Most patients in this general GI clinic IBD database were AA (76%) and for both CD and UC, there was a higher percentage of AA females with IBD as compared to Non-AA patients. CD patients were more likely to have severe disease as defined by CRP and AA had higher values than Non-AA. CD patients were more likely to be on biologics and combination therapy. While AA were more likely to have elevated CRP at first visit, there were no racial or gender differences in the use of biologics or combination therapy which were both more frequent in CD than UC.

Renal Dysfunction and Recovery following Initial Treatment of Newly Diagnosed Multiple Myeloma.

Introduction Renal insufficiency (RI) in Multiple Myeloma (MM) portends a higher tumor burden and worse prognosis. Reversal of RI in newly diagnosed MM (NDMM) improves patient outcomes, but it is unknown if there is a disparity in renal recovery in NDMM between African Americans (AA) and non-African Americans. Methods A retrospective chart review was conducted of 690 patients with NDMM at Rush University Medical Center from 2005 to 2016. 118 patients (59 AA and 59 non-AA) with NDMM and an estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m2 at the time of diagnosis were identified and analyzed. The time to best renal response and best eGFR achieved during initial myeloma therapy were tabulated. Results Median eGFR at the time of diagnosis was similar between the AA and non-AA groups (47.89 versus 51.95, p=0.56). Median absolute change in eGFR after initial therapy was significantly higher in the AA (+33.64) versus the non-AA group (+21.07, p=0.00183). This difference remained whether the baseline eGFR at diagnosis was <90 or <60 mL/min/1.73 m2. Discussion AA patients with NDMM treated in the era of novel agents have greater improvement in renal function in comparison to non-AA patients, regardless of myeloma response. The biological underpinnings for this disparity require further investigation.

Oral hygiene and periodontal conditions in the Chinese patients with aortic aneurysm

BackgroundThis cross-sectional study aims to evaluate the association of periodontal conditions and oral hygiene habits in the Chinese patients with an aortic aneurysm (AA).MethodsA questionnaire and periodontal examinations were carried out in the AA patients and non-AA volunteers recruited from the Center for Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University between August 2011 and June 2016. General information (e.g., height and weight), history of systemic diseases, and oral hygiene habits (e.g., brushing methods and regular oral examinations) were collected in the self-reported survey. Periodontal examinations, such as plaque index and bleeding index, were conducted in all the subjects. The correlation between periodontal indices and AA was further explored using univariate and multivariate analyses.ResultsOur analyses revealed that 87.6% of AA patients have chronic periodontitis, which is significantly higher than that of the non-AA patients (55.8%). In addition, AA patients demonstrated more severe periodontal damages with 69.3% moderate and severe periodontitis, compared to only 16.0% in the non-AA group. Using AA as the dependent variable and all the potential risk factors as covariates (e.g., gender, age, smoking, obesity, diabetes, hypertension, and hyperlipidemia), a logistic regression analysis was performed to show clinical attachment loss (CAL) being an independent risk factor for AA (OR = 2.309, 95% CI: 1.623–3.284, p = 0.000). In comparison with the non-AA patients, more AA patients have poor oral hygiene habits and don’t have regular dental appointments for supra-gingival cleaning.ConclusionPoor periodontal condition and dental hygiene were identified in the AA patients, suggesting that periodontitis-induced CAL may play a role in AA disease mechanisms.

MP06-03 RACE BASED DISPARITIES IN GENE EXPRESSION AND MUTATIONS IN BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2018MP06-03 RACE BASED DISPARITIES IN GENE EXPRESSION AND MUTATIONS IN BLADDER CANCER Kalen Rimar, Joshua Meeks, Sarah Psutka, and Edward Schaeffer Kalen RimarKalen Rimar More articles by this author , Joshua MeeksJoshua Meeks More articles by this author , Sarah PsutkaSarah Psutka More articles by this author , and Edward SchaefferEdward Schaeffer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES African Americans (AA) with urothelial carcinoma (UC) of the bladder have been shown to have worse cancer-specific (CSS) and overall survival (OS). Though several factors including socioeconomic status, access to care, and advanced stage at presentation have been proposed, the cause of this disparity remains undefined. Our objective was to compare bladder cancer gene expression and mutations between AA and Caucasian patients to assess whether the observed disparities in oncologic outcomes could be explained by associated mutational differences. METHODS Using the Bladder/Urothelial Carcinoma Cancer Genome Atlas (BC-TCGA, Provisional) we compared mutation type, frequency, signature, and gene expression between AA and Caucasian patients. We also compared differentially expressed genes according to race across all TCGA provisional cancer datasets that contained a minimum of 10 AA and 10 Caucasian patients per arm (19 of 33). RESULTS We identified 23 AA and 323 non-AA patients in the UC-TCGA dataset with available whole genome and RNA sequencing. There was no significant difference in the total mutation load between Caucasian and AA (range = 1 to 4472 variants/genome, n = 316, median = 240.5 vs. range = 82 to 562 variants/genome; n = 22, median=225.5, p=0.228). The majority of DNA substitution mutations in both Caucasian and AA patients were C->T, and there was no significant difference in frequency (p=0.33). There were no significant differences in Catalogue of Somatic Mutations in Cancer (COSMIC) signatures between the two groups (p=0.3). There was no significant difference in mutation frequency of known UC driver genes (TP53, MLL4, KDM6A, MLL3, PIK3CA, RB1, EP300, ERBB2) by race. Yet, we were able to identify 14 genes with significant differential expression according to race of which HIST1H2BD, L1TD1, and LRRC37A2 were associated with inferior OS (p<0.005, p=0.03, p=0.02). Notably, analyses of TCGA datasets revealed a conserved panel of genes differentially expressed by race across multiple cancers types involved in cell division and nucleosome function. CONCLUSIONS AA and Caucasians with UC have similar mutation type, frequency, and signature. However several differentially expressed genes within the UC were observed between AA and Caucasians and these differences remain consistent across many cancer types within the TCGA suggesting epigenetic regulation. Some of these gene expression differences may be independent of cancer. Nevertheless, the extent to which this differential gene expression may predispose to variable disease outcomes across race warrants further study. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e52-e53 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Kalen Rimar More articles by this author Joshua Meeks More articles by this author Sarah Psutka More articles by this author Edward Schaeffer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Active surveillance of prostate cancer in African-Americans during the MRI era.

108 Background: Many patients with low-risk prostate cancer are encouraged by their physicians to pursue active surveillance (AS). AS has increasingly been utilized, however there remains anxiety by patients and their physicians that more aggressive disease will be missed and allowed to progress. African-American (AA) patients may present with more aggressive disease and higher rates of upgrading at the time of radical prostatectomy. Due to these factors, physicians may be hesitant to recommend AS to AA patients. We examined the role of AS in these patients in the era of MRI targeted biopsies. Methods: A prospectively maintained database was queried for all patients who underwent an MRI guided fusion biopsy from 2007 to 2016 and chose AS as their primary management strategy. Patents with Gleason Group (GG) 1 or 2 were eligible. Patients were then followed with yearly PSA, exam, MRI and biopsy if warranted. MRI Fusion biopsies were reviewed to determine any GG progression. Results: A total of 19 AA and 143 non-AA patients were reviewed with median follow up times of 31.63 (15.42 -89.50) and 30.87 (3.45 – 99.85) months, respectively. AA and non-AA patients had similar baseline PSA values (6.08 ± 2.93 vs. 5.89 ± 4.23, p = 0.85), proportion of GG 1 (15.89% vs 21.68%, p = 0.55) and PSA density (0.103 ± 0.041 vs. 0.123 ± 0.041, p = 0.36. However, AA patients did present at an earlier age (58.89 ± 6.64 vs. 63.69 ± 6.64, p = 0.004). A total of 8/19 (42.1%) AA and 46/143 (32.2%) non-AA had GG upgrading while on AS, p = 0.34. The median time until progression for AA and non-AA patients was 60.76 and 77.42 months, p = 0.68. Conclusions: In our study, AA men did begin AS at an earlier age than non-AA men. While both groups had statistically similar rates of progression, the relative risk of progression was higher in the AA cohort during this time period. Therefore, in the era of MRI and fusion biopsies we are better able to detect upgrading and somewhat mitigate the the risks associated with upgrading during AS irrespective of race but larger studies are needed to determine whether there are meaningful differences in the rates of progression between AA and non-AA men. This research was supported by the Intramural Research Program of the National Cancer Institute, NIH.

Racial disparity in chronic hepatitis B infection in a predominately African American urban clinic population

African Americans (AA) are 4 times as likely as Caucasians to have chronic Hepatitis B (CHB) and yet are under represented in the literature especially with respect to treatment response. The objective of this study was to compare demographics, treatment decisions and outcomes of AA to Non-AA patients seen in the same GI clinic. Of the 92 patients with CHB, 60% were AA. AA patients had similar ALT and viral load at early visits as compared to Non-AA but significantly less fibrosis as defined by AST Platelet Ratio Index. Treatment rates were lower but not statistically different for AA (38%) vs. Non-AA (46%) and the majority of patients (80%) were HBeAntigen (HBeAg) negative. The patients responded well to treatment, although HBeAg positive AA were less likely to have a decline in HBV DNA than HBeAg negative AA patients. The primary conclusions of this study are that AA as compared to Non-AA patients are less likely to have fibrosis and appear to have a dissimilar response to anti-viral therapy.

Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer.

Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients. The study used the Nationwide Inpatient Sample for years 1998-2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume. The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63-0.78; p<0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70-0.87; p<0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p=0.0003), this trend was not significant for the AA patients (p=0.13). In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.

Safety of trifluridine/tipiracil for metastatic colorectal cancer in African American patients participating in an expanded access program.

e15039 Background: A Phase 3 clinical trial (RECOURSE) showed that trifluridine/tipiracil (FTD/TPI) was effective in the treatment of refractory metastatic colorectal cancer (mCRC) (Mayer et al. NEJM 2015;372:1909-19). An expanded-access program (EAP) for patients with refractory mCRC assessed FTD/TPI safety in a real-world setting. One limitation of RECOURSE was the small number of African-American (AA) patients enrolled in the study (n=8). The EAP enrolled 45 AA patients, enabling assessment of FTD/TPI safety in this population. Methods: Patients aged ≥18 years with refractory mCRC resistant to ≥2 regimens of standard chemotherapy and an ECOG performance status of 0 or 1 were enrolled in this open-label EAP. Patients received FTD/TPI 35 mg/m2 twice daily for 5 days followed by 2 days’ rest repeated twice followed by 14 days’ rest over a 28-day treatment cycle until drug discontinuation. We investigated duration of exposure to FTD/TPI and associated adverse events (AEs) in AA patients to compare them with non-AA and US patients from RECOURSE. Results: Median duration of FTD/TPI therapy for AA patients in the EAP was 9.7 weeks, similar to non-AA patients in the EAP (9.7 weeks) and US patients in RECOURSE (8.9 weeks) (differences not statistically significant). 73.3% of AA patients (n=33) in the EAP discontinued treatment due to disease progression and 8.9% (n=4) discontinued due to AEs. AEs related to FTD/TPI are summarized in the table. Conclusions: Lung cancer patients in Eastern North Carolina possess a strikingly poor inflammatory signature with significant implications for quality of life and survival. Clinical trial information: NCT02286492. [Table: see text]

Differences in the immune microenvironment and genomic characteristics of TNBC in African American women compared to other races.

e13028 Background: African American (AA) women are more likely to be diagnosed with triple negative breast cancer (TNBC) compared to other races and have lower pathologic complete response rate to neoadjuvant therapy. Our goal was to assess differences in the immune microenvironment and genomic characteristics of TNBC by race using the TCGA data set. Methods: We compared the expression levels of 13 previously reported immune metagenes (CTL, Mphages, MHC1, Tregs, IF1, NK, STAT1, MHC2, Giam, Tfh, Tinh, Tstim, LCK), histologic tumor infiltrating lymphocyte (TIL) count and overall mutational load, neoantigen load, clonal heterogeneity assessed using the MATH score, amplification and deletion loads of between AA (n = 58) and non-AA TNBC (n = 114). Data was downloaded from the TCGA website, immune metagene expression and MATH scores were calculated as previously reported. Distributions between cohorts were compared using the Mann-Whitney U-test. Results: Among the immune metagenes only the cytotoxic T cell (CTL) metagene showed lower expression in AA patients (3.64 versus 4.08, unadjusted p = 0.046). TIL count was available in 51 of 58 AA and 91 of 114 of non-AA cases, and no significant difference was observed between the racial groups (p = 0.55). We also did not observe statistically significant differences in the mutational load (p = 0.36), neoantigen load (p = 0.38), clonal heterogeneity represented by the MATH score (p = 0.54), and amplification and deletion loads (p = 0.23 and 0.83 respectively) between the two TNBC race groups. We also assess the expression distribution of the immune signatures in an independent Affymetrix gene expression dataset including 40 AA and 323 non-AA patients with TNBC. Similar to the TCGA, there were no significant race differences in the immune signatures, including in the CTL metagene. Conclusions: These results suggest that the differences in prevalence and treatment response seen between TNBC in AA and non-AA patients are unlikely to be due to differences in the immune microenvironment and the genomic landscape of TNBC. However, more subtle comparison in the immune biology of these cancers can only be studies with more focused methods.

Impact of t(11;14) on outcomes in African American (AA) and non-AA (NAA) patients (Pts) with newly diagnosed multiple myeloma (NDMM): Connect MM registry.

8023 Background: t(11;14) is a common cytogenetic abnormality historically associated with standard-risk and generally favorable MM outcomes, but has shown poor prognosis in some retrospective analyses. Connect MM is a prospective, US, observational, multicenter registry that collects data on management and natural history of NDMM pts in clinical practice. The impact of t(11;14) on survival outcomes was assessed in AA and NAA pts. Methods: Adult NDMM pts who completed induction and were tested for t(11;14) by FISH/cytogenetics were grouped by race (AA vs NAA). Endpoints were PFS and OS. Kaplan-Meier analyses were adjusted for differences in cohort, age, ISS stage, transplant intent, t(4;14), hemoglobin, platelets, calcium, creatinine, and diabetes history. Data cutoff was Jul 7, 2016. Results: 3011 pts were enrolled in 2 cohorts (Cohort 1: n = 1493, Sep 2009–Dec 2011, median follow-up = 39.3 mos; Cohort 2: n = 1518, Dec 2012–Apr 2016, median follow-up = 16.4 mos). Of 1539 (52%) pts tested for t(11;14), 363 (24%) were t(11;14)-positive, including 53 (26%) of 205 AA and 310 (23%) of 1334 NAA pts. First-line bortezomib exposure was similar across groups. A trend of shorter PFS was observed in AA pts with t(11;14) vs AA without t(11;14) (Table). AA pts with t(11;14) had significantly higher risk of death compared to those without t(11;14) and higher rate of early mortality than NAA pts. No differences in PFS or OS were noted in NAA pts with or without t(11;14). For OS, the interaction between race and t(11;14) status was statistically significant ( P= 0.004). Conclusions: In Connect MM, the effect of t(11;14) on OS was significantly different between AA and NAA pts. t(11;14) was associated with poorer survival outcomes in AA pts, and thus, may be a risk factor for poor prognosis. Additional analyses will be conducted to elucidate the role of induction treatment, transplant and maintenance in AA and non-AA pts with t(11;14). Clinical trial information: NCT01081028. [Table: see text]

163 - Improved Survival in African American Patients Undergoing Autologous Transplant for Multiple Myeloma in the Chemotherapy and Novel Agent Era

African Americans (AA) have a 2- to 3-fold higher incidence of multiple myeloma (MM) when compared to other racial groups. Evidence suggests that there may be differences in the biology of MM, which confer a more favorable prognosis in AA patients. Prior studies are conflicted as to whether AA patients achieve equal or improved outcomes compared to non-African American (non-AA) patients. Our purpose was to evaluate the impact of AA race on outcomes of MM patients undergoing ASCT at a single center in both the chemotherapy and novel agent era. One hundred and twenty-nine patients who received melphalan 200 mg/m2 and ASCT between 2000 and 2013 were included in the analysis. Sixty-one (47%) patients were African-American and 68 (53%) were non-AA. Baseline characteristics including age, FISH, cytogenetics, paraprotein subtype, median number of prior therapies and International Staging System (ISS) stage were similar between racial groups. Overall, 77 (60%) patients received any novel agent prior to transplant and 52 (40%) received only chemotherapy. More non-AA patients were male (59% vs. 38%, p=0.02), received initial induction with a proteasome inhibitor (59% vs. 28%, p=0.0007), and were treated with post-ASCT maintenance therapy (41% vs. 23%, p=0.008). Time from diagnosis to ASCT in AA patients was 10 (range: 4-144) versus 8 (range: 3-54) months in non-AA patients (p=0.01). The ASCT hospital course was similar between both groups with no significant differences in time to neutrophil and platelet engraftment as well as the duration of hospitalization. Additionally, there was no significant difference in the extra-hematologic toxicity between the two groups including the incidence of diarrhea, mucositis, and infection. Response was measured using the International Myeloma Working Group criteria and was assessed immediately prior to transplant and between 90 to 180 days after transplant. No differences were observed in pre-transplant (p=0.13) or post-transplant (p=0.28) response rates between the two groups. African American patients had a significantly improved median OS compared to non-AA patients (not reached vs. 108 months, p=0.03). We further stratified analyses of OS by those treated in the chemotherapy versus novel agent era. Improved OS was observed in both the chemotherapy (93 vs. 68 months, p=0.02) and novel agent (not reached vs. 79 months, p=0.01) treatment era. In a multivariate Cox proportional hazards model, AA race was associated with improved overall survival (adjusted HR 0.30, 95% CI 0.11 to 0.81; p=0.017). Multiple myeloma has one of the most apparent ethnic disparities in incidence and outcomes among cancers. In our study, AA patients had a longer time to transplant and received less proteasome inhibitor-based induction and post-ASCT maintenance suggesting disparities in access to care. Despite these differences in treatment, we observed improved overall survival after ASCT compared to non-AA patients. We demonstrated this improved OS in patients who had received either chemotherapy or novel agents prior to ASCT. These findings provide further evidence for more favorable outcomes among AA patients. One explanation could be a difference in disease biology that may result in a lower risk disease. Investigation of these biologic differences between AA and non-AA MM patients may increase our understanding of the pathogenesis and future treatments of myeloma. Disclosures No relevant conflicts of interest to declare.

Abstract P5-10-06: Race associated disparities in an urban population of adolescent and young adult (AYA) women with breast cancer

Abstract Introduction: Although only about 5-7% of breast cancers occur in women under 40 years of age, multiple studies have shown that these cancers are more aggressive. In addition issues related to genetic testing and fertility preservation are of particular importance for AYA patients with breast cancer. This retrospective analysis aims to describe various biologic and treatment related factors of an urban AYA population with breast cancer and the differences amongst these factors stratified by African American (AA) versus non-AA race. We will look at factors including stage at diagnosis, hormone receptor status, prevalence of BRCA1/2 mutations, time from diagnosis to treatment, enrollment in clinical trials, and fertility preservation. Methods: A retrospective study of a population of AYA women with breast cancer seen at two hospitals in Washington D.C. from 2006 to 2015 was performed. Data was collected on age, BRCA1/2 test results, stage at diagnosis, hormone receptor status, time from diagnosis to treatment, enrollment in clinical trial, fertility preservation, and pregnant or breastfeeding status at time of diagnosis. Fisher exact test was used to test the association between two categorical variables. Wilcoxon rank sum test was used to compare time to treatment and stage at presentation between AA and non-AA patients. Results: A total of 161 AYA patients were evaluated. 54 were identified as AA and 107 as non-AA (88 Caucasians, 13 Asian, 6 Hispanics). Median age was 32 years (20-39) overall; 32 years (23-39) for AA and 33 years (20-39) for non-AA. While the rate of genetic testing was high, significantly fewer AA AYA underwent testing compared to non-AA (74% versus 87% respectively, (p=0.050)) and 10% of AA versus 22% of non-AA were found to have a BRCA1/2 deleterious mutation (p=NS). Clinical trial participation was lower for AA compared to non-AA (57% vs. 76%, p=NS) for those where clinical trials were discussed/offered. Fertility preservation was pursued by 10% of AA vs. 35% of non-AA (p=0.001). Of note, 61% of AA and 34% of non-AA had children at the time of diagnosis (p=0.001). While AA (31%) presented more often with advanced stages of cancer compared to non-AA (19%) this was not statistically significant. Triple negativity was similar in AA AYA (25%) vs. non-AA (22%). The median time to treatment initiation did not vary between AA and non-AA (37 days vs. 36 days, p=NS). Conclusion: In this retrospective study of an urban population of AYA women with breast cancer, there were no delays in treatment initiation or significant differences between AA and non-AA. When compared to non-AA, AA had a statistically significant lower rate of genetic testing and fertility preservation, although the latest could have been affected by a higher number of nulliparous in non-AA. . Encouragingly, the clinical trial participation of AYA who had previously discussed clinical trials with their physician was very high. Citation Format: Chitalia AA, Aqbal D, Yin R, Cai L, Isaacs CJ, Lynce FC. Race associated disparities in an urban population of adolescent and young adult (AYA) women with breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-06.

Polymorphisms of CCNB1 Associated With the Clinical Outcomes of Platinum-Based Chemotherapy in Chinese NSCLC Patients.

As a crucial cell cycle regulator and G2/M phase promotor, CCNB1 played an essential role in progression of chemotherapy related cell death. Platinum-based chemotherapy is still the first-line chemotherapy regimen for most advanced NSCLC patients. We aim to investigate the correlation of CCNB1 polymorphisms to the efficiency of platinum-based chemotherapy in Chinese advanced NSCLC patients. We enrolled 972 patients with advanced NSCLC, and extracted DNA from their peripheral blood for genotyping CCNB1 four tagSNPs which selected from the Hapmap database. We analyzed the association of CCNB1 four tagSNPs with efficiency of platinum-based chemotherapy. We found that rs2069429 and rs2069433 of CCNB1 were associated with the OS of advanced NSCLC patients. Patients with GG genotype of rs2069429 had longer OS than non-GG patients (HR=0.81, 95%CI=0.68-0.95, p=0.009); and patients with AA genotype of rs2069433 had longer OS than non-AA patients (HR=0.78, 95%CI=0.61-0.98, p=0.036). And the haplotype GAAA of CCNB1 was a putative factor in subgroup patients with clinical stage IV. The association of CCNB1 polymorphisms and toxicities after platinum-based chemotherapy was assessed. Rs2069433 and rs350104 were related with gastrointestinal toxicity of platinum-based chemotherapy. The patients with GG genotype of rs2069433 (p=0.013) and/or non-GG genotype of rs350104 (p=0.042) may have a severe gastrointestinal toxicity after chemotherapy, and then clinician may can reduce the dosage of chemotherapy agents to avoid sever toxicities in these patients. In summary, CCNB1 polymorphisms may contribute to the clinical efficiency of platinum-based chemotherapy in advanced NSCLC patients, and it is helpful for the personalized treatment.

Disparities in Renal Recovery Between African Americans Vs. Non African Americans Following Initial Treatment of Newly Diagnosed Multiple Myeloma: A Retrospective Chart Review

Introduction:Renal insufficiency (RI) in newly diagnosed multiple myeloma (NDMM) represents a poor prognostic factor (Knudsen, Hjorth, and Hippe 2000). Recent clinical trials have demonstrated that patients treated with novel agents, particularly proteasome inhibitors, may experience renal recovery with improvement in overall survival (Dimopoulos et al. 2013; Gonsalves et al. 2015). The majority of patients in these trials were Caucasians, although multiple myeloma is twice as common in African Americans (AA) as it is in Caucasians. Moreover, AA have a 5 times higher rate of stage 4 chronic kidney disease (CKD) and end-stage-renal-disease (ESRD) in the United States compared to Caucasians. The cause for this disparity is thought to be multifactorial, including a higher incidence of comorbidities such as diabetes and hypertension among AAs (Williams and Pollak 2013; Grams et al. 2013). There is currently a dearth of evidence regarding renal recovery in AA receiving therapy for MM. The goal of this study is to compare renal recovery between AA and non AA patients following initial treatment for NDMM.Methods:We performed a retrospective chart review of patients with NDMM at Rush University Medical Center from January 1, 2005 to August 1, 2016. 690 charts were selected and reviewed; patients who were on hemodialysis for alternative reasons prior to diagnosis, had a GFR > 90, or for whom records were incomplete were excluded. 118 patients with NDMM and a GFR < 90 (corresponding to National Kidney Foundation’s chronic kidney disease stage 2 or worse) at the time of diagnosis were identified. Continuous variables were compared between the two groups using the Mann-Whitney U test, and binary variables were compared using Fisher’s exact test.Results:We compared 59 AA and 59 non AA patients with RI at the time of diagnosis of MM. Both groups were comparable by age, gender, ISS and high risk cytogenetics. The degree of RI at the time of diagnosis was similar: median GFR at diagnosis was 47.89 in the AA group and 51.95 in the non AA group (p=0.56). Hypertension was more common in the AA group (78% vs. 52.5%, p=0.0064), while other comorbidities were statistically comparable.The majority of patients were treated with a bortezomib-based regimen (86.4% for the AA group and 84.7% for the non AA group, p=1). MM response rates to induction therapy were similar: very good partial response (VGPR) or better was achieved in 39% of AA and 25.4% of non AA (p=0.17). 45.8% of AA patients underwent autologous stem cell transplant (ASCT) compared to 64.4% of non-AA (p=0.0637, see table 3). 80% of AA and 88% of non AA patients received bisphosphonates (see table 1).Although median GFR at the time of diagnosis of MM was similar between the AA and non AA groups (47.89 vs. 51.95, p=0.56), the median absolute change in estimated GFR after initial therapy was significantly higher in the AA group (+33.64) vs. the non-AA group (+21.07, p=0.00183). This difference remained whether the baseline GFR at diagnosis was <90 or <60 (see table 2). The median time to best renal response was 91 days in AA and 79 days in non-AA (p=0.383).Conclusions:This is the first study to analyze disparities in renal dysfunction and recovery between AA and non-AA patients with NDMM. We demonstrate that in our institution AA patients with NDMM treated in the era of novel agents have greater improvement in renal function in comparison to non AA patients. Given that renal recovery in NDMM impacts overall survival, this finding suggests that further studies should be done to explore differences in the epidemiology and disease biology that could account for the racial disparities in renal dysfunction and recovery. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Improved Survival in African American Patients Undergoing Autologous Transplant for Multiple Myeloma in the Chemotherapy and Novel Agent Era

African Americans (AA) have a 2- to 3-fold higher incidence of multiple myeloma (MM) when compared to other racial groups. Evidence suggests that there may be differences in the biology of MM, which confer a more favorable prognosis in AA patients. Prior studies are conflicted as to whether AA patients achieve equal or improved outcomes compared to non-African American (non-AA) patients. Our purpose was to evaluate the impact of AA race on outcomes of MM patients undergoing ASCT at a single center in both the chemotherapy and novel agent era.One hundred and twenty-nine patients who received melphalan 200 mg/m2 and ASCT between 2000 and 2013 were included in the analysis. Sixty-one (47%) patients were African-American and 68 (53%) were non-AA. Baseline characteristics including age, FISH, cytogenetics, paraprotein subtype, median number of prior therapies and International Staging System (ISS) stage were similar between racial groups. Overall, 77 (60%) patients received any novel agent prior to transplant and 52 (40%) received only chemotherapy. More non-AA patients were male (59% vs. 38%, p=0.02), received initial induction with a proteasome inhibitor (59% vs. 28%, p=0.0007), and were treated with post-ASCT maintenance therapy (41% vs. 23%, p=0.008). Time from diagnosis to ASCT in AA patients was 10 (range: 4-144) versus 8 (range: 3-54) months in non-AA patients (p=0.01). The ASCT hospital course was similar between both groups with no significant differences in time to neutrophil and platelet engraftment as well as the duration of hospitalization. Additionally, there was no significant difference in the extra-hematologic toxicity between the two groups including the incidence of diarrhea, mucositis, and infection.Response was measured using the International Myeloma Working Group criteria and was assessed immediately prior to transplant and between 90 to 180 days after transplant. No differences were observed in pre-transplant (p=0.13) or post-transplant (p=0.28) response rates between the two groups. African American patients had a significantly improved median OS compared to non-AA patients (not reached vs. 108 months, p=0.03). We further stratified analyses of OS by those treated in the chemotherapy versus novel agent era. Improved OS was observed in both the chemotherapy (93 vs. 68 months, p=0.02) and novel agent (not reached vs. 79 months, p=0.01) treatment era. In a multivariate Cox proportional hazards model, AA race was associated with improved overall survival (adjusted HR 0.30, 95% CI 0.11 to 0.81; p=0.017).Multiple myeloma has one of the most apparent ethnic disparities in incidence and outcomes among cancers. In our study, AA patients had a longer time to transplant and received less proteasome inhibitor-based induction and post-ASCT maintenance suggesting disparities in access to care. Despite these differences in treatment, we observed improved overall survival after ASCT compared to non-AA patients. We demonstrated this improved OS in patients who had received either chemotherapy or novel agents prior to ASCT. These findings provide further evidence for more favorable outcomes among AA patients. One explanation could be a difference in disease biology that may result in a lower risk disease. Investigation of these biologic differences between AA and non-AA MM patients may increase our understanding of the pathogenesis and future treatments of myeloma. DisclosuresNo relevant conflicts of interest to declare.

Decreased Use of Sphincter-Preserving Procedures among African-American Patients with Rectal Cancer

Background Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients.

African Americans and Short-Term Outcomes after Surgery for Crohn's Disease: An ACS-NSQIP Analysis.

Previous reports on racial disparities in the treatment of Crohn's disease [CD] in African American [AA] patients have shown differences in both medical and surgical treatments in this population. No study thus far has examined the effect of AA race on outcomes after surgery for CD. Utilizing the National Surgical Quality Improvement Program [NSQIP] Participant User File [PUF] for the years 2005-2013, we examined the effect of AA race on postoperative complications in patients with CD undergoing intestinal surgery. AA patients had a significantly higher rate of complications overall compared to non-AA patients [23.5% vs 18.9%, p = 0.002]. Postoperative sepsis [10.9% vs 6.6%, p < 0.001] and surgical site infection [17.6% vs 14.8%, p = 0.037] were most significant. After adjustment for age, sex, preoperative disease severity and lifestyle factors [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model. African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.

(316) - Characteristics and Outcomes of African American LVAD Recipients: A Single Center Experience

African Americans (AA) have a higher prevalence of heart failure than other racial/ethnic groups. Furthermore, AA with heart failure have a higher mortality and those who undergo heart transplantation have a lower survival. The outcomes and survival of AA patients who undergo LVAD implantation is not well defined. We performed a single center retrospective review of patients implanted with a LVAD between January, 2010 and September, 2015. We compared clinical characteristics and survival of AA vs. all other patients. A total of 278 patients underwent LVAD implantation, of whom 170 (61%) were AA. Compared to non-AA patients, the AA group had a longer mean time on LVAD support (560±473 vs. 445±465 days, p=0.05). AA were younger (54±12.5 vs. 59±13.6 years, p<0.001), included more women (35% vs. 19%, p=0.003), had a higher BMI (29.4±6.5 vs. 27.0±5.5, p=0.001), had more non-ischemic cardiomyopathy (76% vs 41%, p<0.001), and had less previous sternotomies (13% vs. 29%, p=0.001). There were no significant differences between the 2 groups in the pre-operative INTERMACS profiles, kidney/liver function, implant strategy (BTT or DT), or the type of LVAD (axial vs. centrifugal pump). During the index hospitalization for LVAD implantation, there were no significant differences between the AA and non-AA groups in terms of days on vasopressor or inotropic therapy and length of stay (30.4±20.6 vs. 26.1 ±21.1, p=0.09),. After discharge, the rate of 30-day re-hospitalization was similar between the 2 groups (27% vs 24%, p=0.58). AA had a lower unadjusted mortality at 90 days (12.4% vs. 23.8%) and at 1 year (Figure). This is the largest reported cohort of AA with LVADs from a single institution. AA race did not adversely affect length of stay, early re-hospitalization or survival after LVAD implantation. Whether race impacts thrombotic, bleeding, or infectious complications deserves further study.