Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute‐designated cancer centers in California

Ho, Gwendolyn; Wun, Ted; Muffly, Lori; Li, Qian; Brunson, Ann; Rosenberg, Aaron S; Jonas, Brian A.; Keegan, Theresa H.M.

doi:10.1002/cncr.31296

Cited by 48 publications

(44 citation statements)

References 37 publications

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“…Asians and women are known to have a higher prevalence of EGFR mutations (59,60), which explains our finding of an increased likelihood of TKI use in these groups. We also observed that patients treated at NCI-designated centers were more likely to receive any systemic treatment and TKIs, consistent with studies that have observed better adherence to guideline concordant care at NCI-designated cancer centers (61,62). However, NCI designation did not affect the likelihood of receiving treatment with bevacizumab.…”

Section: Discussionsupporting

confidence: 88%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear.Methods: Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields.Results: A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments.Conclusions: Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts.Impact: Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.

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Section: Discussionsupporting

confidence: 88%

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Maguire

Morris

Parikh‐Patel

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Two recent studies reported significantly higher early mortality rates among patients treated in non-academic versus academic centers, and in non-NCI-designated versus NCI-designated cancer centers 166,167 . In a National Cancer data Base of 60,738 patients with AML, the 1-month mortality was 16% in academic centers and 29% in non-academic centers (p < 0.001), and the 5-year survival rate was 25% versus 15 % (p < 0.001) 166,167 . The second study from California in 7007 patients with AML reported an early mortality rate in AML of 12% in NCIdesignated cancer centers versus 24% in non-NCIdesignated cancer center 167 .…”

Section: Translating the Published Literature Into Realworld Experiencementioning

confidence: 99%

Acute myeloid leukemia: current progress and future directions

et al. 2021

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Progress in the understanding of the biology and therapy of acute myeloid leukemia (AML) is occurring rapidly. Since 2017, nine agents have been approved for various indications in AML. These included several targeted therapies like venetoclax, FLT3 inhibitors, IDH inhibitors, and others. The management of AML is complicated, highlighting the need for expertise in order to deliver optimal therapy and achieve optimal outcomes. The multiple subentities in AML require very different therapies. In this review, we summarize the important pathophysiologies driving AML, review current therapies in standard practice, and address present and future research directions.

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“…81 A second study of 7007 patients reported an early mortality rate of 12% in NCI-designated cancer centers versus 24% in non-NCI-designated cancer centers. 82 At MD Anderson, the 4-week mortality rate with intensive chemotherapy is <5%; the early mortality rate with low-intensity regimens in older patients with AML is 2% to 3%. Whenever logistically possible, we encourage AML treatment in leukemia centers of excellence.…”

Section: How To Choose Between Intensive and Lower-intensity Chemothementioning

confidence: 99%

Acute myeloid leukemia: Treatment and research outlook for 2021 and the MD Anderson approach

Kantarjian

Kadia

DiNardo

et al. 2021

Cancer

108

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The unraveling of the pathophysiology of acute myeloid leukemia (AML) has resulted in rapid translation of the information into clinical practice. After more than 40 years of slow progress in AML research, the US Food and Drug Administration has approved nine agents for different AML treatment indications since 2017. In this review, we detail the progress that has been made in the research and treatment of AML, citing key publications related to AML research and therapy in the English literature since 2000. The notable subsets of AML include acute promyelocytic leukemia (APL), core-binding factor AML (CBF-AML), AML in younger patients fit for intensive chemotherapy, and AML in older/unfit patients (usually at the age cutoff of 60-70 years). We also consider within each subset whether the AML is primary or secondary (therapy-related, evolving from untreated or treated myelodysplastic syndrome or myeloproliferative neoplasm). In APL, therapy with all-trans retinoic acid and arsenic trioxide results in estimated 10-year survival rates of ≥80%. Treatment of CBF-AML with fludarabine, high-dose cytarabine, and gemtuzumab ozogamicin (GO) results in estimated 10-year survival rates of ≥75%. In younger/fit patients, the "3+7" regimen (3 days of daunorubicin + 7 days of cytarabine) produces less favorable results (estimated 5-year survival rates of 35%; worse in real-world experience); regimens that incorporate high-dose cytarabine, adenosine nucleoside analogs, and GO are producing better results. Adding venetoclax, FLT3, and IDH inhibitors into these regimens has resulted in encouraging preliminary data. In older/unfit patients, low-intensity therapy with hypomethylating agents (HMAs) and venetoclax is now the new standard of care. Better low-intensity regimens incorporating cladribine, low-dose cytarabine, and other targeted therapies (FLT3 and IDH inhibitors) are emerging. Maintenance therapy now has a definite role in the treatment of AML, and oral HMAs with potential treatment benefits are also available. In conclusion, AML therapy is evolving rapidly and treatment results are improving in all AML subsets as novel agents and strategies are incorporated into traditional AML chemotherapy.

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Decreased early mortality associated with the treatment of acute myeloid leukemia at National Cancer Institute‐designated cancer centers in California

Cited by 48 publications

References 37 publications

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

Acute myeloid leukemia: current progress and future directions

Acute myeloid leukemia: Treatment and research outlook for 2021 and the MD Anderson approach

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