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Disparities in PI3K/mTOR inhibitor use, toxicities, and outcomes among patients with metastatic breast cancer

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Abstract

Purpose

Novel agents such as PI3K and mTOR inhibitors (PI3K/mTORi) have expanded treatment options in metastatic breast cancer (MBC). Nevertheless, mortality rates remain disproportionately high for Black patients and patients with lower socioeconomic status. Furthermore, clinical trials for these novel agents lacked diversity, so their toxicity profile in minority populations is uncertain.

Methods

We conducted a retrospective analysis of EHR-derived data from the Flatiron Health Database for patients with HR+, HER2− MBC. Multivariable logistic regression was used to evaluate factors associated with PI3K/mTORi use and toxicity outcomes.

Results

A total of 9169 patients with MBC were included in our analysis, of which 1780 (19.4%) received a PI3K/mTORi. We estimated the conditional total effect of insurance through Medicaid, and found lower odds of use of PI3K/mTORi among patients on Medicaid compared to those with commercial insurance (OR 0.73, 95% CI 0.54–0.99, p = 0.049). Odds of PI3K/mTORi use were higher for patients treated at an academic center (OR 1.28, CI 1.06–1.55, p = 0.01). Modeled as a controlled direct effect, Black/African American (Black/AA) race had no impact on odds of PI3K/mTOR use. Black/AA patients had twice the odds of developing hyperglycemia on PI3K/mTORi compared to White patients (OR 2.02, CI 1.24–3.39, p < 0.01).

Conclusion

This analysis of real-world data suggests that the use of PI3K/mTORi is influenced by socioeconomic factors. We also found racial disparities in toxicity outcomes, with Black/AA patients having twice the risk of hyperglycemia. Our findings call for greater efforts to ensure access to novel treatments and improve their tolerability in diverse populations.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research was partially funded by the American Cancer Society (DLH) and the Breast Cancer Research Foundation (DLH). The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Claire Sathe, Melissa K. Accordino, David DeStephano, Jason D. Wright & Dawn L. Hershman

  2. Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Mansi Shah

Authors
  1. Claire Sathe
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  2. Melissa K. Accordino
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  3. David DeStephano
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  4. Mansi Shah
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  5. Jason D. Wright
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  6. Dawn L. Hershman
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Contributions

All authors contributed to the study conception and design, as well as to data collection and analysis. The first draft of the manuscript was written by CS, DD, and DLH, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Claire Sathe.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This is an observational study of de-identified patient data. All necessary approvals and/or exemptions have been obtained from the CUIMC Institutional Review Board.

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Sathe, C., Accordino, M.K., DeStephano, D. et al. Disparities in PI3K/mTOR inhibitor use, toxicities, and outcomes among patients with metastatic breast cancer. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07337-3

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