Treatment of Acute Myeloid Leukemia in Older Adults

Acute Myeloid Leukemia (AML) is an aggressive myeloid malignancy predominantly affecting older adults. Despite the advancements in new therapies for AML, older and medically unfit patients continue to suffer from poor outcomes due to disease-related factors such as the mutational profile and patient-related factors such as comorbidities and performance status. In this review, we discuss a spectrum of therapeutic options for older patients with AML starting with a historical perspective and ending with therapies being investigated in clinical trials. We review the standard of care treatment options including combination venetoclax and hypomethylating agents, in addition to targeted therapies such as FLT3 and IDH inhibitors. Lastly, we shed light on challenges facing the care of older adults and their representation in clinical trials.

Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors

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Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.

Abstract P1-08-06: Changes in breast cancer diagnosis and treatment after Medicaid expansion in Pennsylvania

Background: In January 2015, Pennsylvania expanded Medicaid eligibility to all legally present adults in the Commonwealth of Pennsylvania with household incomes up to 138 percent of the federal poverty level under the Affordable Care Act. Pennsylvania is the most populous state to expand Medicaid that did not previously have a large expansion of the program to adults, making it an ideal setting to study the impacts of the program. By March 2017, an estimated 716,000 people had enrolled in Pennsylvania's expanded Medicaid program. We aim to determine how Pennsylvania's Medicaid expansion has impacted breast cancer diagnosis and treatment in the state.

Methods: The Pennsylvania Cancer Registry was queried for all women aged 18 to 64 years newly diagnosed with breast cancer between 2007 and 2015. Demographic, tumor, and treatment characteristics were evaluated for each year during this time span. In order to assess the impact that Medicaid expansion had on these variables, they were compared for the years 2007 to 2014 (before Medicaid expansion) and the year 2015 (after).

Results: Between 2007 and 2015, 49,606 cases of invasive breast cancer were diagnosed among women aged 18-64 and residing in the state of Pennsylvania, 43,920 of which were diagnosed and treated between 2007 and 2014, and 5,686 of which were diagnosed and treated in 2015. Initial analysis indicates that more women were diagnosed with localized breast cancer (SEER summary stage 1) following Medicaid expansion in 2015 compared to the period of 2007 to 2014 (63.07% v. 60.62%, p = 0.0004). Meanwhile, the proportion of women diagnosed with metastatic breast cancer did not change before and after Medicaid expansion (6.52% v. 6.86%, p = 0.3298). Subsequent analysis will assess changes in treatment outcomes including time to treatment and receipt of guideline-concordant care.

Conclusion: The expansion of Medicaid in Pennsylvania in 2015 under the Affordable Care Act resulted in an increase in the proportion of localized (SEER summary stage 1) breast cancer diagnoses, though there was no change in the proportion of metastatic cases in the first year following expansion. The results suggest a possible increase in earlier stage diagnosis associated with increased access to health insurance. Additional analysis will examine the impact on treatment-related outcomes.

Citation Format: Spada N, Geramita E, van Londen G, Sabik L. Changes in breast cancer diagnosis and treatment after Medicaid expansion in Pennsylvania [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-06.