Real-world burden of chemotherapy-induced myelosuppression in patients with small cell lung cancer: a retrospective analysis of electronic medical data from community cancer care providers

Abstract

Aims

Chemotherapy-induced myelosuppression, which commonly exhibits as neutropenia, anemia, or thrombocytopenia, represents a substantial burden for patients with cancer that affects health-related quality of life and increases healthcare resource utilization (HCRU). We evaluated the burden of myelosuppression among chemotherapy-treated patients with small cell lung cancer (SCLC) using real-world data from community cancer care providers in the Western United States.

Materials and methods

This was a retrospective, observational analysis of electronic medical records (EMRs) from Providence St. Joseph Health hospital-associated oncology clinics between January 2016 and December 2019. Patient demographics were assessed from the date of first SCLC diagnosis in adult patients with chemotherapy-induced grade ≥3 myelosuppression in first-line (1L) or second-line-and-beyond (2L+) treatment settings. Myelosuppressive adverse events (AEs), treatment patterns, and HCRU were assessed from the date of chemotherapy initiation (index date) until 12 months, date of the last visit, date of death, or study end, whichever occurred earliest.

Results

Of 347 eligible patients with SCLC who had received chemotherapy (mean age 66; 49% female), all had received at least 1L treatment, and 103 (29.7%) had a 2L + treatment recorded within the EMR during the study period. Of 338 evaluable patients with longitudinal laboratory data, 206 (60.9%) experienced grade ≥3 myelosuppressive AEs, most commonly neutropenia, anemia, and thrombocytopenia (44.9, 41.1, and 25.4 per 100 patients, respectively). Rates of granulocyte colony-stimulating factor use and red blood cell transfusions were 47.0 and 41.7 per 100 patients, respectively. There was a trend toward increasing the use of supportive care interventions and visits to inpatient and outpatient facilities in patients with myelosuppressive AEs in more than one cell lineage.

Conclusions

Chemotherapy-induced myelosuppression places a substantial real-world burden on patients with SCLC in the community cancer care setting. Innovations to protect bone marrow from chemotherapy-induced damage have the potential to reduce this burden.

PLAIN LANGUAGE SUMMARY

This study looked at the medical records of people with a particular type of lung cancer known as small cell lung cancer. When treated with chemotherapy, people with this cancer may develop a condition called myelosuppression. This causes people to have fewer blood cells, which can lead to tiredness, or increase the risk of infection or bleeding. The study looked at what types of chemotherapy people with small cell lung cancer were given, what the side effects of myelosuppression were, how often the side effects were reported, and what treatments were given to manage these side effects. The study also looked at whether people with side effects from myelosuppression needed more visits to the doctor or hospital. Around 3 out of 5 people in the study experienced serious side effects resulting in reduced numbers of white blood cells (which fight infection), red blood cells (which carry oxygen), or platelets (which help the blood to clot), and many needed drugs or blood transfusions to treat these side effects. On average, people with side effects from myelosuppression had more visits to healthcare facilities than those people without these side effects. The findings suggest that myelosuppression places a large burden on people with small cell lung cancer who are treated with chemotherapy.

Keywords:

• Chemotherapy
• healthcare resource use
• hematologic toxicity
• myelosuppression
• small cell lung cancer
• supportive care

JEL CLASSIFICATION CODES:

• I11
• I1
• I
• I00

Transparency

Declaration of funding

This study was funded by G1 Therapeutics, Inc. The study sponsor provided support in the form of salary for TS at the time of study and consultancy fees to RSE, RKW, ASP, and JK, and was involved in the study design, collection, analysis, and interpretation of data, writing of the report, and the decision to submit the report for publication. Epstein Health LLC. and Providence Health & Services provided support in the form of salaries for RSE and JK, and RKW and ASP, respectively, but did not have any additional role in the study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Declaration of financial/other relationships

RE is an employee of Epstein Health, LLC and has received research funding and consultancy fees from G1 Therapeutics, Inc. Outside of the submitted work, RE is a board member for Fate Therapeutics, Illumina, and Veracyte, and has received consultancy fees from Halozyme, Intracellular Therapies, Merck, Otsuka, Radius Health, and Taiho Oncology. RKW is an employee of Providence Health & Services, and has received consultancy fees from G1 Therapeutics, Inc. ASP is an employee of Providence Health & Services, and has received consultancy fees from G1 Therapeutics, Inc. Outside of the submitted work, ASP owns stock in IQVIA. JK is an employee of Epstein Health, LLC and has received consultancy fees from G1 Therapeutics, Inc. Outside of the submitted work, JK owns stock in Cigna, Express Scripts, and Medco Health Solutions. Outside of the submitted work, RS has received honoraria from Amgen and AstraZeneca, consultancy fees from Amgen, AstraZeneca, AbbVie, Ariad, Celldex, EMD Serono, Genentech-Roche, Peregrine Pharmaceuticals, Seattle Genetics, and Takeda, expenses from Five Prime Therapeutics and Janssen Oncology, and institutional research grants from Bristol-Myers Squibb, MedImmune, and Merck. TS was an employee of G1 Therapeutics, Inc., at the time of study completion, and is currently a paid employee of Taiho Oncology, Inc.

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Authors contributions

All authors were involved in the study conception and design and/or analysis and interpretation of the data, drafting the paper and/or revising it critically for intellectual content, approved the final version to be published, and agree to be accountable for all aspects of the work.

This work was presented at the American Society of Clinical Oncology 2020 congress and published in the abstract supplement (DOI: 10.1200/JCO.2020.38.15_suppl.e19300, Journal of Clinical Oncology 38, no. 15_suppl).

Acknowledgements

The medical writing support was provided by Curo and Alligent Europe (Divisions of the Envision Pharma Group), funded by G1 Therapeutics, Inc. The authors would like to thank Huan Huang (G1 Therapeutics, Inc.) for her invaluable support in the development and revision of this manuscript.

Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.