Breast cancer remains the most common cancer diagnosis in women in the United States, and enduring the often debilitating cancer treatments can become as harrowing as the diagnosis itself.
That’s especially true for Black women, who face disparate outcomes in breast cancer and are more likely to experience neuropathy. A side effect from chemotherapy that causes numbness, tingling and pain in the hands and feet, neuropathy is the primary reason patients cannot complete prescribed chemotherapy, which compromises cure rates.
Researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center are leading the way to improving quality of life and curative chemotherapy doses for Black patients with breast cancer — with help from the patients themselves.
In a clinical study led by IU physician-scientist Dr. Bryan P. Schneider, researchers have discovered that Black patients with breast cancer experience less neuropathy and less reductions in their chemotherapy dose when treated with a chemotherapy drug called docetaxel. These findings represent an important shift in knowledge about a patient population that has historically been underrepresented in breast cancer research.
Researchers collaborated with Black patient advocates in the trial design and patient recruitment, specifically with guidance from the Indianapolis-based organization Pink-4-Ever Ending Disparities. Focus groups helped inform the study’s design, recruitment and educational materials, which included a social media campaign that featured Black women with breast cancer.
“The EAZ171 clinical study was built off about a decade of work at IU, including a large breast cancer trial that showed that Black patients or patients of African descent were markedly more likely to get toxicity from chemotherapy, and particularly taxane-induced peripheral neuropathy,” said Schneider, the Vera Bradley Professor of Oncology at the IU School of Medicine.
Taxane-based chemotherapies are the primary curative therapy for breast cancer, but they can lead to taxane-induced peripheral neuropathy. Neuropathy can be irreversible and impact a cancer survivor’s life forever.
“As we dug a little deeper, we found that this side effect also caused physicians to have to reduce the chemotherapy doses, which ultimately led to inferior survival outcomes specifically for Black patients,” Schneider said. “Given the disparities that we see with Black patients in terms of survival and toxicity, we felt compelled to address this head-on.”
The study is among the first National Cancer Institute cooperative group trials to focus enrollment solely on a minority population that has disparate outcomes. The trial enrolled only women who self-identified as Black or African American. IU physician-scientist Dr. Tarah J. Ballinger presented results from the study in June at the 2024 American Society of Clinical Oncology Annual Meeting.
“The most important implication from this study for Black women with breast cancer is that we found that a specific chemotherapy drug, docetaxel, was associated with significantly less neuropathy compared to a drug called paclitaxel,” said Ballinger, the Vera Bradley Foundation Scholar in Breast Cancer Research at the IU School of Medicine. “We saw less neuropathy, and we saw less dose reductions of life-saving therapy.”
Previously, paclitaxel has been the standard of care for breast cancer, but Ballinger said this study indicates that docetaxel may be the preferred drug specifically for Black women.
“Moving forward, this is potentially a way that we can improve disparities in breast cancer outcomes,” Ballinger said.
When Saysha Wright was diagnosed with breast cancer in 2019, she was raising two young children and getting ready to start nursing school. Wright was among the first women to enroll in the trial, hoping she could make a difference for other Black women facing the disease.
“They told me that the type of chemotherapy I was getting affects African American women in a negative way,” she said. “That’s what made me want to be a part of the trial; I wanted to help other women.”
Wright’s treatment-induced neuropathy appeared a couple of weeks after she began taxane-based chemotherapy and continued about three weeks after her treatment ended.
“I just thank God that it didn’t last forever,” she said.
Wright described it as the temporary feeling of tingling and numbness when a body part falls asleep, except with neuropathy the feeling doesn’t go away.
“I experienced it in my fingers and my toes, like I couldn’t feel when I tried to braid my baby’s hair or button up her shirt,” she said. “I had no feeling in my fingers.”
Today, Wright is busy keeping up with her son, who plays football, and her daughter, who likes to dance. After her treatment ended, she started nursing school to become a registered nurse. She said her personal experience with cancer and her caring medical team, including Ballinger, have made her a better nurse.
Schneider and Ballinger are investigators at the Vera Bradley Foundation Center for Breast Cancer Research at the IU Simon Comprehensive Cancer Center. For Schneider, the study is a continuation of IU breast cancer research focused on personalized medicine.
“The idea here is really thinking about identifying the right drug for the right patient at the right time, and really embracing the idea that not only do we want patients to live long and to be cured, we want them to live well,” he said.
Wright said it feels amazing to know that her participation in the clinical trial has contributed to a new understanding of how to improve breast cancer treatments for Black women.
“All I wanted to do was to potentially help women who might have to go through what I went through,” Wright said. “I’m really honored that they are making progress because neuropathy is not fun, especially for those who have to experience it forever.”
