Older Patients With AML Less Likely to Receive Genomic Testing, Study Finds

In a real-world setting of new and emerging targeted therapies, a study found that patients with acute myeloid leukemia (AML) had unmet needs that hindered their ability to receive genomic testing and treatment options, especially for older patients with AML.

The retrospective analysis, published in Cancer Medicine, aimed to evaluate the frequency of genomic testing and patterns of treatment by age in patients with newly diagnosed AML within both academic and community-based health care systems.

“To adequately describe the future impact of targeted therapies on outcomes, GT [genomic testing] and treatment patterns in the real world need to be evaluated together,” wrote the researchers. “Indeed, in the community, alteration of practice pattern may be necessary to fully appreciate the benefit of any therapy appreciated in the context of a large center-derived treatment approach for AML.”

AML is the most common form of acute leukemia and is the leading cause of leukemia-related deaths in the United States, with an estimated 20,380 new cases and 11,310 AML deaths in 2023. Although retrospective studies have found patients with AML treated at high-patient-volume academic or National Cancer Institute centers had improved outcomes compared with those treated at lower patient-volume or at smaller community practices or hospitals, little is known about the treatment patterns and outcomes in a combined health system setting.

Data were collected from the Indiana University Health System Enterprise Data Warehouse, as well as 2 local cancer registries of patients ages 18 years and older with newly diagnosed AML between January 1, 2011, to June 30, 2018. A total of 2595 patients were identified among the 3 data sources, and after exclusion and eliminating duplicates, 629 patients were included in the analysis.

Of these patients, 285 (45%) were 60 years and younger, 202 (32%) were between 61 to 74 years, and 142 (23%) were 75 years and older. The primary outcome variables identified were the proportion of patients with genomic analysis and frequency of mutations.

The analysis showed 13% of newly diagnosed patients with AML had evidence of a genomic sequencing report, which increased to 37% since 2016. Additionally, genomic testing was more likely to be performed in patients 60 years and younger compared with patients over 60 years (45% vs 30%; P = .03), treated in academic hospitals compared with community hospitals (44% vs 26%; P = .01), and in chemotherapy recipients than non-therapy recipients (46% vs 26%; P < .001).

Furthermore, the most common mutations found were ASXL1, NPM1, and FLT3, with patients 75 years and older having the highest proportion (46%) of 3 or more mutations.

In total, 31.2% of patients with AML did not receive any therapy, with this subgroup of patients being older than chemotherapy recipients (mean age, 71.4 vs 55.7 years; P < .001). The proportion of patients who did not receive therapy was highest (66.2%) in patients 75 years and older.

The researchers acknowledged some limitations to the study, including knowing that the databases and registries used do not capture the cost of testing or insurance reimbursement, or access to next-generation sequencing and genomic testing.

Despite these limitations, the researchers believe the study showed a higher rate of genomic testing within academic hospitals and centers compared with smaller, community hospitals and practices, and that patients 75 and older were less likely to receive testing and treatments.

“In this new era of targeted therapies, our results highlight the unmet medical need to increase access to GT and chemotherapy treatment particularly to older patients in the real-world setting, where most patients receive treatment,” wrote the researchers.

Reference

Byrd JC, Gatz JL, Louis CL, et al. Real‐world genomic testing and treatment patterns of newly diagnosed adult acute myeloid leukemia patients within a comprehensive health system. Cancer Medicine. Published online August 28, 2023. doi:10.1002/cam4.6442