A comparison of complete pathologic response rates following neoadjuvant chemotherapy among South African breast cancer patients with and without concurrent HIV infection

Sarah Nietz, Daniel S. O’Neil, Oluwatosin Ayeni, Wenlong Carl Chen, Maureen Joffe, Judith S. Jacobson, Alfred I. Neugut, Paul Ruff, Witness Mapanga, Ines Buccimazza, Urishka Singh, Sharon Čačala, Laura Stopforth, Boitumelo Phakathi, Tobias Chirwa, Herbert Cubasch

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: Among patients diagnosed with breast cancer (BC), women also living with HIV (WLWH) have worse survival than women without HIV. Chronic HIV infection may interfere with the effectiveness of BC treatment, contributing to this disparity. We attempted to determine the impact of HIV infection on response to neoadjuvant chemotherapy (NACT) among South African women with BC. Methods: We evaluated women from the South African Breast Cancer and HIV Outcomes cohort study who had stage I–III disease, initiated NACT, underwent definitive breast surgery, and had available surgical pathology reports. We compared pathologic complete response (pCR) rates among women with and without HIV infection, using multivariable logistic regression to control for differences in tumor characteristics. We also evaluated the impact of HIV infection on pCR within subgroups based on patient and tumor factors. Results: Of 715 women, the 173 (24.2%) WLWH were less likely to achieve pCR than women without HIV (8.7% vs 16.4%, [odds ratio (OR) 0.48, 95% confidence interval (95% CI) 0.27–0.86]). WLWH continued to have lower likelihood of achieving pCR on multivariable analysis (OR 0.52, 95% CI 0.28–0.98). A similar pattern was seen within subgroups, although HIV infection appeared to affect pCR more in ER/PR-positive BC (OR 0.24, 95% CI 0.08–0.71) than in ER/PR-negative BC (OR 0.94, 95% CI 0.39–2.29). Conclusion: WLWH were less like to achieve pCR following NACT for BC than women without HIV. This reduced response to systemic therapy may contribute to the poorer BC outcomes seen in WLWH.

Original languageEnglish (US)
Pages (from-to)861-872
Number of pages12
JournalBreast cancer research and treatment
Volume184
Issue number3
DOIs
StatePublished - Dec 2020

Keywords

  • Global oncology
  • HIV
  • Neoadjuvant chemotherapy response
  • South Africa

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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