Severe myelosuppression common after chemotherapy for small cell lung cancer
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Key takeaways:
- Nearly two-thirds of patients had grade 3 or higher myelosuppressive episodes after chemotherapy for extensive-stage small cell lung cancer.
- Almost all patients required supportive care after chemotherapy.
Nearly all individuals who received chemotherapy for extensive-stage small cell lung cancer experienced a treatment-related myelosuppressive episode, results of a retrospective study published in Cancer Medicine showed.
“The findings indicate that there is a high burden related to myelosuppression among chemotherapy-treated patients with [extensive-stage small cell lung cancer] in the community oncology setting,” the researchers wrote. “Mitigating or preventing the myelotoxic effects of chemotherapy has the potential to reduce the burden.”
Background
Myelosuppression is a common toxicity related to treatment with certain types of chemotherapy and is a “highly prevalent issue” when treating patients with extensive-stage small cell lung cancer, according to Lowell L. Hart, MD, FACP, scientific director of clinical research at Florida Cancer Specialists & Research Institute and lead author of the study.
“It can be detrimental to the treatment process and outcomes, often causing delays in care and added complications,” he said in a press release. “Conducting this study was an important step to understanding how [myelosuppression] affects this highly vulnerable patient population.”
Methodology
Researchers conducted a retrospective cohort study of adults with extensive-stage small cell lung cancer who received chemotherapy to determine the burden of treatment-related myelosuppression and volume of related supportive care in a community setting.
The investigators collected structured electronic medical record data of 1,239 patients (mean age, 66.9 ± 9.3 years; 49.7% men; 58% white) who initiated at least one line of therapy that included chemotherapy at Florida Cancer Specialists & Research Institute between September 2013 and November 2020.
Frequency of myelosuppressive episodes by type and severity grade across all lines of therapy served as the study’s primary outcome measurement. Secondary outcome measurements included time to myelosuppressive episodes, treatment patterns, eligibility to receive red blood cell or platelet transfusions, and supportive care use.
Researchers noted a mean follow-up of 10.4 ± 11.3 months after index chemotherapy initiation.
Key findings
Results showed 1,222 patients (98.6%) experienced at least one myelosuppressive episode across all chemotherapy-containing lines of therapy during the study’s follow-up period.
Investigators reported 62.1% of patients had grade 3 or higher myelosuppressive episodes during at least one chemotherapy-containing line of therapy. Approximately one-third (33.9%) of patients experienced grade 3 or higher myelosuppression during at least two lines, and 15.5% reported having grade 3 or higher episodes across three lines of chemotherapy-containing therapy.
Ninety-four percent of patients required the use of supportive care during the study’s follow-up period, including granulocyte colony-stimulating factor supplementation (89.7%), erythropoiesis-stimulating agents (24.4%) and IV volume expansion (52.1%).
Researchers identified nearly one-third (32.6%) of those in the cohort as eligible to receive a red blood cell transfusion based on a follow-up hemoglobin level of less than 8 g/dL.
Clinical implications
Real-world data, such as that used in this study, can be used to analyze the effectiveness of treatment regimens in specific patient populations, according to Lucio N. Gordan, MD, president and managing physician at Florida Cancer Specialists & Research Institute and one of the study’s co-authors.
“In this particular case, we identified myelosuppression as a significant disruptor to the treatment of [extensive-stage small cell lung cancer],” he said in the release. “Moving forward, we can integrate steps to mitigate or prevent these types of adverse effects.”
References:
- Florida Cancer Specialists & Research Institute. New study evaluates effects of chemotherapy-induced myelosuppression for extensive-stage small cell lung cancer (press release). Available at: https://flcancer.com/articles/new-study-evaluates-effects-of-chemotherapy-induced-myelosuppression-for-extensive-stage-small-cell-lung-cancer-data-from-florida-cancer-specialists-research-institute/. Published April 13, 2023. Accessed May 19, 2023.
- Hart L, et al. Cancer Med. 2023;doi:10.1002/cam4.5738.
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