Abstract 6259: Molecular biomarker testing and targeted therapy patterns in patients with acute myelogenous leukemia (AML): A real-world data analysis
Authors: Law Jeanna Wallenta , Gul Zartash , Berry Anna , Thompson Michael A. , Willner Christopher , Vuyyala Sowjanya , McCracken Haley , Geverd Katherine , Wolf Frank M. , Brown Thomas D. , Kuriakose Philip 
Published: June 2022

Background and Objective: Molecular testing and targeted treatments for patients (pts) diagnosed with AML have evolved in recent years. Real-world testing patterns, including next-generation sequencing (NGS), and clinical management of pts with AML were analyzed in 2 large U.S. community health systems.

Methods: Pts &gt;18 years, diagnosed with AML from January 1, 2015 to December 31, 2020, were identified in a database containing clinical and genomic data from integrated community delivery networks. Study end was March 31, 2021, allowing for 3 months minimum follow up. Actionable biomarkers were defined by NCCN guidelines version 3, 2021.

Results: The study included 685 pts, median age of 70 and median follow up of 5.4 months; 55% were male, 73% non-Hispanic White (NHW), 10% non-Hispanic Black (NHB). 69% had de novo AML. Cytogenetic prognostic classification was: 4% favorable; 33% intermediate; 30% adverse; and 33% unknown. 541 (79%) pts, median age of 69, received NGS or single gene/small panel tests. 144 (21%) pts with no testing had a median age of 78. Pts with de novo AML were more likely to be tested compared to secondary AML (84% vs. 67%, p&lt;0.001). No significant difference was found in testing receipt between NHW and NHB pts (82% vs. 76%, p=0.3). 80% of pts received NGS testing in upfront setting, 15% in relapse setting (&gt;30 days after diagnosis), 5% were unknown. 77% of pts diagnosed in 2020 received NGS tests (Table 1). 52/100 (52%) of pts with FLT3 (ITD or TKD) mutation, 5/27 (19%) with IDH1 mutation and 11/44 (25%) with IDH2 mutation received targeted therapy.

Conclusions: Molecular biomarker testing has increased over time with NGS becoming the dominant modality. Testing uptake did not differ by race. Half of pts with FLT3 mutation received targeted therapy, one fifth with IDH1 and one quarter with IDH2 mutations. Future research should explore targeted therapy receipt over time and address gaps in uptake for pts with AML in the community setting.

Table 1. Proportion of patients with molecular biomarker testing by diagnosis year among (n=685) Diagnosis Year 2015(N = 77) 2016(N = 92) 2017(N = 113) 2018(N = 138) 2019(N = 129) 2020(N = 136) Overall(N = 685) NGS testing, n (%) 7 (9%) 17 (18%) 46 (41%) 100 (72%) 100 (78%) 105 (77%) 375 (55%) Other non-NGS molecular biomarker testing only, n (%) 48 (62%) 52 (57%) 38 (34%) 14 (10%) 14 (11%) 0 (0%) 166 (24%) Molecular biomarker testing (NGS and/or other), n (%) 55 (71%) 69 (75%) 84 (74%) 114 (83%) 114 (88%) 105 (77%) 541 (79%) Proportion tested by actionable biomarker, n (%) FLT3-ITD 51 (66%) 64 (70%) 77 (68%) 108 (78%) 106 (82%) 94 (69%) 500 (73%) FLT3-TKD 50 (65%) 63 (68%) 76 (67%) 105 (76%) 106 (82%) 90 (66%) 490 (72%) IDH2 5 (6%) 10 (11%) 34 (30%) 95 (69%) 100 (78%) 102 (75%) 346 (51%) IDH1 5 (6%) 10 (11%) 28 (25%) 91 (66%) 101 (78%) 102 (75%) 337 (49%)

Citation Format: Jeanna Wallenta Law, Zartash Gul, Anna Berry, Michael A. Thompson, Christopher Willner, Sowjanya Vuyyala, Haley McCracken, Katherine Geverd, Frank M. Wolf, Thomas D. Brown, Philip Kuriakose. Molecular biomarker testing and targeted therapy patterns in patients with acute myelogenous leukemia (AML): A real-world data analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6259.