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Race Not a Factor in Dose Intensity or Toxicity Among Patients Treated for Endometrial Cancer: Presented at SGO

By Ed Susman

TAMPA, Fla -- March 12, 2008 -- Researchers attempting to determine why outcomes appear to favour white over black women with advanced endometrial cancer say chemotherapy dose intensity and overall toxicity can be ruled out as factors that relate to the disparities.

"Black and white patients with advanced-stage or recurrent endometrial cancer were similar with respect to dose intensity and chemotherapy-related toxicity, suggesting that previously described racial disparities in chemotherapy among patients in Gynaecologic Oncology Group trials may have a biological aetiology," said Lt. Col. John H. Farley, MD, Professor of Obstetrics and Gynaecology, Uniformed Services University, Health Sciences, Bethesda, Maryland.

"Survival among African Americans with cancer in the United States tends to be decreased [compared with their white counterparts]," Lt. Col. Farley said in a presentation on March 11 at the Society of Gynaecologic Oncologists (SGO) 2008 Annual Meeting on Women's Cancer.

"Blacks are less likely to have endometrial cancer than whites, but blacks' mortality is much greater than whites. In 2007 we expect 5-year survival among whites with endometrial cancer to be about 86%, while for blacks the 5-year survival falls to 61%," he said.

In his retrospective study that included 977 white women and 168 black women, Col. Farley reported that 82.1% of the whites and 82.3% of blacks experienced some form of grade 3 or 4 adverse events during the course of treatment for endometrioid, clear-cell, serous, and other types of gynaecological cancers.

"Importantly, when race was analysed as an independent covariate, it was not associated with the failure to complete therapy," Lt. Col. Farley said. "When looking at our outcome variables, relative dose, relative time, and relative dose intensity, we found no differences in these treatment parameters between blacks and whites enrolled in this study. Similar numbers of blacks and white completed the prescribed 7 cycles of chemotherapy required by the protocols."

Similar numbers of black and whites -- more than 60% -- were taken off therapy due to progression of disease and about 27% of blacks and whites discontinued therapy due to toxicities, he said.

A higher percentage of whites than blacks (71.7% vs 56%) were being treated for recurrent disease; more blacks had stage IV disease than whites (31.6% vs 21.2%); more blacks had stage III disease compared with whites (12.5% vs 7.2%). All the differences were statistically significant (P = .002).

When the researchers looked at overall factors that affected outcomes, they determined that the relative dose was an independent predictor of survival for all patients in the study. Among patients who received more than 90% of the protocol dose, median survival was 19.6 months, compared with 13.4% for patients who received less than 90% of the protocol dose.


[Presentation title: Chemotherapy Intensity and Toxicity Among Black and White Women With Advanced and Recurrent Endometrial Cancer -- Experience From Gynecologic Oncology Group Clinical Trials. Abstract 40]

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