Disparities in uptake of novel therapies for acute myeloid leukemia.

Abstract

6540 Background: Multiple novel therapies have recently been approved to treat acute myeloid leukemia (AML). Inequities in the uptake of novel treatments have been seen in other cancers but are not known for this population. Methods: We performed a retrospective analysis of the nationwide Flatiron Health electronic health record (EHR)-derived deidentified database. We assessed sociodemographic associations with novel AML therapies use within two-years of Food and Drug Administration (FDA) approval from 1/2014-8/2022. Therapies were: glasdegib, venetoclax, ivosidenib, midostaurin, CPX-351, gilteritinib, enasidenib, and gemtuzumab ozogamicin (GO). Univariable associations were assessed using X2 testing. Logistic regression modeling of community practices assessed associations between novel therapy receipt and sociodemographics adjusted by treatment year. Variable categories are shown. Results: Of 8081 patients in 280 clinics, 3102 (38%) received at least one novel therapy. The cohort was predominately older (69; interquartile range [57, 77]), male (56%), non-Hispanic (NH)-White (88%), and treated at a community practice (75%). There were 4808 patients treated within 24-months of a novel therapy approval, of which 1937 (40%) received a novel therapy. Venetoclax represented 59% of novel treatments prescribed. Bivariate associations were seen between novel therapy receipt within 24-months of approval and high SES and non-Hispanic (NH)-White race-ethnicity; similar associations were seen when assessed at the treatment regimen level. In a logistic regression model of community practices (N=2,459), older patients (OR 1.01; 95%CI 1.00, 1.02), females (OR 1.2; 95% CI 1.0,1.4), and those from high (vs low) SES (OR 1.4; 95%CI 1.1, 1.6) were more likely to receive novel therapy; there were no associations with sex or race-ethnicity. Conclusions: In this large national database of adults with AML, almost half received novel therapy within 24-months of FDA approval. Though there was no dichotomous difference in uptake by race-ethnicity in community practices, younger and more affluent patients were more likely to receive novel therapy, concerning for disparities in uptake. [Table: see text]