Treatment patterns and burden of myelosuppression for patients with small cell lung cancer: A SEER‐medicare study

Epstein, Robert S.; Nelms, Jerrod; Moran, Donald M.; Girman, Cynthia J.; Huang, Huan; Chioda, Marc

doi:10.1016/j.ctarc.2022.100555

Cited by 6 publications

(9 citation statements)

References 48 publications

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“…Our findings are consistent with previous studies in the real‐world setting, which have reported that grade ≥ 3 myelosuppressive AEs are common among patients with ES‐SCLC treated with chemotherapy (56.6–64.1%) 39 , 40 and among patients with SCLC treated with chemotherapy (grade ≥ 3 = 60.9%; any grade with inpatient admission = 74.3%). 41 , 42 Rates of myelosuppressive events in this study were similar between the index LOT and all LOTs suggesting that myelosuppressive events occur early in the ES‐SCLC treatment course, rather than only during later LOTs. A notable proportion (33.9%) of patients experienced myelosuppressive episodes in at least two blood cell lineages, underscoring the multilineage burden of myelosuppression among patients with ES‐SCLC undergoing chemotherapy treatment.…”

Section: Discussionsupporting

confidence: 53%

“… 5 Around half of patients went on to receive at least one further LOT, which is concordant with the 52.1% of elderly patients with SCLC who received a second or subsequent treatment in a recent Surveillance, Epidemiology and End Results (SEER)‐Medicare analysis, but higher than the 29.7% of SCLC patients with documented second‐ or later‐line treatment within the Providence St. Joseph Health EMR dataset. 41 , 42 Although NCCN Guidelines® now recommend platinum/etoposide plus immunotherapy as preferred options for patients with ES‐SCLC, 5 the relatively low uptake of chemo‐immunotherapy in the current study can be attributed to the fact that more than 70% of patients had an index treatment date before 2019 (atezolizumab approved in March 2019 for the first‐line treatment of ES‐SCLC in combination with carboplatin and etoposide 32 ; durvalumab approved in March 2020 for the first‐line treatment of ES‐SCLC in combination with either cisplatin/etoposide or carboplatin/etoposide 43 ).…”

Section: Discussionmentioning

confidence: 99%

“…The rate was slightly higher than observed in previous real‐world studies for G‐CSF use (47%–84%) but within the reported range for ESA use (2%–27%). 39 , 40 , 41 , 42 , 44 As reflected in the large variation among these studies, differences in methodology and reporting preclude any direct comparisons of healthcare resource use between studies.…”

Section: Discussionmentioning

confidence: 99%

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Burden of chemotherapy‐induced myelosuppression among patients with extensive‐stage small cell lung cancer: A retrospective study from community oncology practices

et al. 2023

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Background Myelosuppression is a major dose‐limiting complication of chemotherapy for patients with extensive‐stage small cell lung cancer (ES‐SCLC). The objective was to describe the burden of myelosuppression, treatment patterns, and supportive care use among patients with ES‐SCLC treated with chemotherapy in a US community oncology setting. Methods This retrospective cohort study used structured electronic medical record (EMR) data from the Florida Cancer Specialists & Research Institute between January 2013 and December 2020. Adult patients with ES‐SCLC who were treated with chemotherapy between September 2013 and November 2020 were identified. The index date was the date of the first chemotherapy‐containing line of therapy (LOT). Patients were followed for a minimum of 30 days after index (unless patient died) until December 31, 2020, or end of activity in the EMR data, whichever occurred first. Incidence and frequency of myelosuppressive episodes/events, treatment patterns, eligibility for red blood cell (RBC) or platelet transfusions, and supportive care use (granulocyte colony‐stimulating factor [G‐CSF], erythropoiesis‐stimulating agents [ESAs], intravenous [IV] hydration) during the follow‐up period were reported. Results The study population included 1239 patients. Most (94.0%) patients started first‐line chemotherapy at index. During follow‐up and across all chemotherapy‐containing LOTs, 1222 (98.6%) patients had at least 1 myelosuppressive episode; 62.1% of patients had grade ≥ 3 myelosuppressive episodes in at least one lineage, 33.9% had grade ≥ 3 myelosuppressive episodes in at least two lineages, and 15.5% had grade ≥ 3 myelosuppressive episodes in all three lineages. Supportive care use included 89.7% of patients who received G‐CSF, 24.4% who received ESAs, and 52.1% who received IV volume expansion. Almost one‐third (32.6%) of patients were eligible to receive RBC transfusions based on lab values (hemoglobin < 8 g/dL). Conclusion There is a high burden related to multilineage myelosuppression among chemotherapy‐treated patients with ES‐SCLC in the community oncology setting. Reducing myelosuppression could make chemotherapy treatment safer, reduce the need for supportive care, and potentially prevent the treatment of complications.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Burden of chemotherapy‐induced myelosuppression among patients with extensive‐stage small cell lung cancer: A retrospective study from community oncology practices

et al. 2023

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“…Of note, in our model we have included a dimensionless coefficient ݂ ‫א‬ [0 ,1] that represents an immunosuppression factor to modulate the carrying capacity (i.e., homeostasis levels) of the naïve immune cell population to model immunocompromised subjects, such that ݂ ൌ 1 in healthy individuals, and ݂ ൏ 1 in immunocompromised patients. Note that since our model is calibrated for patients who are immunocompromised due to anticancer therapy, therefore immunosuppression in our model is characterized by T-and B-cell immunodeficiency, which is one of the important immunological effects observed due to disruption of hematopoiesis leading to myelosuppression in patients undergoing anticancer therapy [53][54][55][56][57]. Also, in the case of naïve CD4+ and CD8+ T-cells we have included the ability of interleukin-6 (IL-6) to cause T-cell exhaustion [58] by including an additional term that limits the carrying capacity of these cells.…”

Section: Equation For the Naïve Apc Density At The Site Of Vaccinatio...mentioning

confidence: 99%

A modeling-based approach to optimize COVID-19 vaccine dosing schedules for improved protection

Dogra

Schiavone

Wang

et al. 2022

Preprint

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While the development of different vaccines has slowed the dissemination of SARS-CoV-2, the occurrence of breakthrough infections continues to fuel the pandemic. As a strategy to secure at least partial protection, with a single dose of a given COVID-19 vaccine to maximum possible fraction of the population, delayed administration of subsequent doses (or boosters) has been implemented in many countries. However, waning immunity and emergence of new variants of SARS-CoV-2 suggest that such measures may jeopardize the attainment of herd immunity due to intermittent lapses in protection. Optimizing vaccine dosing schedules could thus make the difference between periodic occurrence of breakthrough infections or effective control of the pandemic. To this end, we have developed a mechanistic mathematical model of adaptive immune response to vaccines and demonstrated its applicability to COVID-19 mRNA vaccines as a proof-of-concept for future outbreaks. The model was thoroughly calibrated against multiple clinical datasets involving immune response to SARS-CoV-2 infection and mRNA vaccines in healthy and immunocompromised subjects (cancer patients undergoing therapy); the model showed robust clinical validation by accurately predicting neutralizing antibody kinetics, a correlate of vaccine-induced protection, in response to multiple doses of mRNA vaccines. Importantly, we estimated population vulnerability to breakthrough infections and predicted tailored vaccination dosing schedules to maximize protection and thus minimize breakthrough infections, based on the immune status of a sub-population. We have identified a critical waiting window for cancer patients (or, immunocompromised subjects) to allow recovery of the immune system (particularly CD4+ T-cells) for effective differentiation of B-cells to produce neutralizing antibodies and thus achieve optimal vaccine efficacy against variants of concern, especially between the first and second doses. Also, we have obtained optimized dosing schedules for subsequent doses in healthy and immunocompromised subjects, which vary from the CDC-recommended schedules, to minimize breakthrough infections. The developed modeling tool is based on generalized adaptive immune response to antigens and can thus be leveraged to guide vaccine dosing schedules during future outbreaks.

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“…For most LS SCLC patients, concurrent chemoradiation is the standard of care; only patients with stage I to stage IIA (T1-2, N0) SCLC are recommended for surgery. Thus, fewer than 5% of SCLC patients undergo surgery, and most SCLC patients are diagnosed (unexpectedly) with SCLC during surgery [ 7 , 8 ]. Some evidence supports a role for surgery when LS SCLC patients have been precisely staged.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Tumor Location Predicts a Favorable Prognosis in Patients with Resected Small Cell Lung Cancer

Gao

Dong

Zhou

et al. 2022

International Journal of Clinical Practice

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Background. Small cell lung cancer (SCLC) is an aggressive malignancy. Surgical resection is currently only recommended for clinical stage I patients who have been carefully staged. The clinical outcomes of patients with resected SCLCs vary because the disease is highly heterogeneous, suggesting that selected patients could be considered for surgical resection depending on their clinical and/or molecular characteristics. Methods. We collected data on a retrospective cohort of 119 limited-stage SCLC patients who underwent lobectomy with mediastinal lymph node dissection from March 2013 to March 2020 at Harbin Medical University Cancer Hospital. Correlations were derived using Fisher’s exact test. Models of 2-year and 3-year survival were evaluated by deriving the area under receiver operating characteristic curves. Kaplan–Meier and Cox regression analyses were used to evaluate significant differences between the survival curves and hazard ratios. Results. The median disease-free survival (DFS) was 35.9 months (range 0.9–105.3 months), and the median overall survival (OS) was 45.2 months (range 4.8–105.3 months). Univariate analysis showed that TNM stage was significantly correlated with DFS and OS. The 2-year disease-free rates of patients with stage I, II, and III disease were 76.4%, 50.5%, and 36.1%, respectively, and the 3-year OS rates were 75.9%, 57.7%, and 34.4%, respectively. In pN + patients, multiple (or multiple-station) lymph node involvement significantly increased recurrence and reduced survival compared with patients with single or single-station metastases. Patients with peripheral SCLCs evidenced significantly better DFS and OS than did patients with central tumors. Multivariate analysis showed that TNM stage and tumor location were independently prognostic in Chinese patients with resected limited-stage SCLC. A combination of TNM stage and tumor location was helpful for prognosis. Conclusions. TNM stage and tumor location were independently prognostic in Chinese patients with resected SCLCs. Patient stratification by tumor location should inform the therapeutic strategy. The role of surgical resection for limited-stage SCLC patients must be reevaluated, as this may be appropriate for some patients.

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Treatment patterns and burden of myelosuppression for patients with small cell lung cancer: A SEER‐medicare study

Cited by 6 publications

References 48 publications

Burden of chemotherapy‐induced myelosuppression among patients with extensive‐stage small cell lung cancer: A retrospective study from community oncology practices

Burden of chemotherapy‐induced myelosuppression among patients with extensive‐stage small cell lung cancer: A retrospective study from community oncology practices

A modeling-based approach to optimize COVID-19 vaccine dosing schedules for improved protection

Peripheral Tumor Location Predicts a Favorable Prognosis in Patients with Resected Small Cell Lung Cancer

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