Understanding Racial and Ethnic Disparities in Modern AML Care After the Approval of Venetoclax
Use of venetoclax may increase survival in non-Hispanic Black patients with acute myeloid leukemia (AML), according to recent findings presented by Wang et al at the 2023 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 955).
Although the standard treatment of AML has been intensive chemotherapy, many older patients may be ineligible to receive this treatment because of the risk of severe side effects and poor survival. However, in November 2018, the novel targeted therapy venetoclax—in combination with other agents—was approved to treat patients with AML. As a result, patients who would typically be considered too old or sick for chemotherapy may now have access to a viable treatment option.
“Historically, AML has been a very difficult cancer to treat, so we’re encouraged to see outcomes improving—including the narrowing of health disparity gaps for the first time,” highlighted lead study author Xin Wang, MD, a third-year fellow in the Department of Hematology-Oncology at the University of Pennsylvania Perelman School of Medicine. “Racial and ethnic disparities in cancer care are complex, but our study shows that when novel therapies are brought into the ‘real-world’ setting, including community hospitals, we can move the needle. On the clinical research side, we need to take advantage of these opportunities to better serve previously underrepresented, understudied populations,” she added.
Study Methods and Results
In this retrospective study, researchers used a nationwide electronic health record–derived database to compare the survival rates of 3,000 adults diagnosed with AML between January 2014 and December 2018 with those of 2,000 patients diagnosed with AML between January 2019 and October 2022—after the introduction of venetoclax into clinical settings.
They hoped to better understand the existing racial and ethnic disparities in AML and sought to assess whether the approval of new low-intensity treatments and a subsequent shift toward more outpatient and community-based care delivery could impact these disparities.
The researchers discovered that since the approval of venetoclax, the survival rate of patients with AML has improved among non-Hispanic Black patients and patients aged 70 and older. After the investigators adjusted for age and comorbidities, the predicted 2-year overall survival rate for non-Hispanic Black patients with AML increased from 28.6% to 45.3%, mitigating the survival gap compared with non-Hispanic White patients. The survival rates did not improve among Hispanic patients after the approval of venetoclax.
Additionally, the researchers reported that the median age of the patients involved in the more recent study group was 71 years compared with 68.5 years among those in the earlier study group.
“These results are the first step to better understanding racial and ethnic disparities in modern AML care and should be explored further in broad, multi-institutional prospective collaborations,” emphasized co–senior study author Kelly Getz, PhD, MPH, Assistant Professor of Epidemiology and Pediatrics at the University of Pennsylvania Perelman School of Medicine.
The researchers plan to continue evaluating how other factors may have impacted the overall survival trends. They noted that their new findings have illuminated the evolving racial and ethnic disparities in AML survival; however, more studies may be needed to progress the understanding of why such outsized improvement was seen in non-Hispanic Black patients. This patient population was underrepresented in venetoclax clinical trials, and it remains unclear whether biological factors such as cancer mutations, nonbiological factors such as subsequent therapy and/or access to care, or a combination of both may be responsible for the improved outcomes.
“We hope to extend this work with basic science, translational, and qualitative research experts to obtain a more comprehensive view,” underscored co–senior study author Catherine Lai, MD, MPH, Associate Professor of Hematology-Oncology at the University of Pennsylvania Perelman School of Medicine and Physician Leader of the Leukemia Clinical Research Unit at the Abramson Cancer Center at Penn Medicine. “Ultimately, our goal is to further improve the outcomes of all patients with this very challenging disease,” she concluded.
Disclosure: The research in this study was supported by the National Institutes of Health and a Health Equity Research Pilot Award from the Perelman School of Medicine Division of Hematology-Oncology. For full disclosures of the study authors, visit ash.confex.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.