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

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.