Many older adult patients with acute myeloid leukemia (AML) are treated in the frontline setting with nonconventional therapies, but treatment patterns are changing even though many still receive no treatment. These study results were published in the journal Cancer.
The study was a population-based analysis of records from the California Cancer Registry and the Patient Discharge Database for the state of California. Included patients were aged 60 years and older with a primary AML diagnosis occurring between 2014 and 2017. Demographic and clinical data were analyzed with respect to frontline treatment regimen and outcomes.
Frontline treatment regimens were categorized as having a conventional chemotherapy backbone, nonconventional therapy, or no treatment. Nonconventional therapy consisted of hypomethylating agents, venetoclax, liposomal anthracycline and cytarabine, or oral targeted agents.
A total of 3068 patients met inclusion criteria for analysis. A backbone of conventional chemotherapy was used in frontline treatment in 36% of patients. Nonconventional therapy was used with 42% of patients, and 22% were given no frontline treatment.
Frontline nonconventional therapy became more common over time; in 2014, 38% of the patients received this, and in 2017, 47% of the patients did (P <.0001). Conventional therapy was given to 26% of patients in 2014, compared to 23% in 2018 (P <.0001). The receipt of treatment remained relatively steady, with 23% receiving no treatment in 2014 and 24% receiving no treatment in 2017 (P =.20). In 2014, 14% of patients underwent hematopoietic stem cell transplantation, whereas 18% of patients underwent the procedure in 2017 (P <.0001).
Multivariable analyses revealed features associated with receipt of treatment. Patients in younger age groups, those who had fewer than 2 comorbidities, and those who received initial care at a National Cancer Institute-designated cancer center (NCI-CC) were more likely to have received frontline treatment.
Among patients receiving frontline treatment, compared with those given conventional therapy, patients who received nonconventional therapy were more likely to be older, have 2 or more comorbidities, Black race/ethnicity, and have public health insurance. They also had fewer hospital admissions and inpatient days.
The 1-year overall survival (OS) rates were 44% with conventional chemotherapy, 31.4% with nonconventional therapy, and 4.4% with no treatment (P <.001). An independent factor contributing to better OS was whether the patient received frontline treatment at an NCI-CC, while age 80 years and older and presence of 2 or more comorbidities were each associated with worse OS.
“Our data highlight that, at a population level, there remains significant opportunity to increase access to treatment for older adults, especially those who present to non–NCI-CCs,” the study investigators reported.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Kennedy VE, Keegan THM, Li Q, Maguire FB, Muffly LS. Frontline treatment patterns and outcomes among older adults with acute myeloid leukemia: a population-based analysis in the modern era. Cancer. 2022;128(1):139-149. doi:10.1002/cncr.33873