Blue Ridge Cancer Care’s Goldschmidt Presents Data on Managing Hematological Events

What is an abstract involving patients with small cell lung cancer (SCLC) doing at a meeting on hematology?

As Jerome Goldschmidt, MD, an oncologist at Blue Ridge Cancer Care, in Blacksburg, Virginia, explained, the findings aren’t about SCLC per se, but about managing common hematological adverse events (HAEs) that can occur when patients are treated with chemotherapy. Many patients experience anemia, neutropenia, and thrombocytopenia, and managing these events—or better yet, preventing them—is key to patients staying on the recommended dose of therapy and avoiding AEs that lead to costly hospital stays. (Blue Ridge Cancer Care is part of The US Oncology Network.)

Goldschmidt served as principal investigator for a retrospective, observational study conducted with Ontada, an oncology real-world data and evidence, clinical education and provider technology business of McKesson. Their findings were presented during the 2021 American Society of Hematology Meeting & Exposition.¹

Investigators used iKnowMed electronic health record data from January 1, 2015, through January 31, 2020, to identify patients for the study. Goldschmidt said that about 1400 patients fit the overall inclusion criteria, and patients were then divided into 2 groups: those who had experienced a grade ≥3 HAE and those who had not. Investigators found that 778 patients experienced a grade ≥3 HAE during that period. “That’s a majority of the patients,” Goldschmidt said in an interview with Evidence-Based Oncology™ during the meeting in Atlanta.

Digging deeper, the analysis showed that myelosuppression HAEs in extensive-stage SCLC bring a heavy burden in the community oncology setting. “We looked at the burden on patients, which translated into transfusions, missed doses, dose reductions, and lower dose intensity,” Goldschmidt said. All of these were higher in patients with grade ≥3 AEs.

Health care costs were higher, too. Goldschmidt noted that the study calculated the differences in outpatient costs only, and they were still substantial. “Our hypothesis was that there would be more health care utilization if you had these adverse events. And indeed, that’s what we showed,” he said.

Health outcomes data from the Ontada analysis showed the following:

• Of those patients with at least one grade ≥3 HAE after starting chemotherapy, 50.3% had grade 3 anemia, 46.0% had grade 3 neutropenia, 28.0% had grade 4 neutropenia, 33.8% had grade 3 thrombocytopenia, and 18.1% had grade 4 thrombocytopenia.
• Of the 778 patients with grade ≥3 HAEs, 454 (58.4%) had 2 or more types, and 12.2% had anemia, neutropenia, and thrombocytopenia.
• 43.1% of the patients were eligible for red-blood-cell infusion, and 3.9% for platelet infusion; 12.2% of patients had major bleeding events.
• Compared with patients who did not have grade 3 HAEs, those with grade ≥3 HAEs were more likely to have dose reductions (46.7% vs 32.2%, respectively); treatment holds (12.7% vs 5.9%); and treatment delays (92.3% vs 84.3%; all P < .001).

Cost of care data underscore the burden of grade ≥3 HAEs:

• Total outpatient costs within 12 months after the start of chemotherapy were higher for patients with vs without grade ≥3 HAEs ($37,613 vs $31,176; P = .004).
• Patients with grade ≥3 HAEs had an mean of 10.7 outpatient visits within 12 months of starting chemotherapy vs 7.7 outpatient visits for those without grade 3 HAEs (P < .0001).
• Patients with grade ≥3 HAEs had greater use of granulocyte colony-stimulating factor, more intravenous hydration, and greater use of erythropoiesis-stimulating agents, at higher costs.

Goldschmidt has studied the use of trilaciclib in this SCLC population. He coauthored an analysis of 3 related studies, which found that administering trilaciclib prior to chemotherapy reduces myelosuppression and improves health-related quality of life for these patients.²

“Pegfilgrastim and filgrastim are phenomenal drugs,” Goldschmidt elaborated, “but they do have their costs, their side effects, and their difficulties in delivery. Plus, they really only treat 1 cell line.” Newer therapies can prevent more hematological events in more cancers and are worth studying, he said.

“Future studies will address the benefits of trilaciclib from the standpoint of health economics, as well as relieving suffering from the patient’s end while on chemotherapy,” said Goldschmidt. “We’ll also look at how it interacts with immunotherapy,” as well as its potential benefits in other types of cancers, such as breast and colon cancer.

References

1. Goldschmidt JS, Monnette A, Shi P, Venkatasetty D, Huang H, Chioda M. Understanding hematological adverse event management through health care resource utilization, costs, and treatment patterns of patients with extensive-stage small cell lung cancer treated in the community oncology setting. Presented at: 63rd American Society of Hematology Annual Meeting & Exposition, December 11-14, 2021; Atlanta, GA. Abstract 1913. https://ash.confex.com/ash/2021/webprogram/Paper148057.htm
2. Weiss J, Goldschmidt JS, Andric Z, et al. Effects of trilaciclib on chemotherapy-induced myelosuppression and patient-reported outcomes in patients with extensive-stage small cell lung cancer: pooled results from three phase II randomized double-blind, placebo-controlled studies. Clin Lung Cancer 2021;22(5):449-460. doi:10.1016/j.cllc.2021.03.010