Outcomes for pembrolizumab stratified by pemetrexed maintenance post pembrolizumab-platinum-pemetrexed induction in metastatic non-small-cell lung cancer.

Aim: We assessed treatment patterns and outcomes in patients with metastatic nonsquamous non-small-cell lung cancer (mNSCLC) who initiated first-line pembrolizumab-platinum-pemetrexed (induction) in US community oncology settings. Methods: Patients initiating induction were retrospectively identified. Patients continuing pembrolizumab afterward underwent chart review. Clinical outcomes were described by maintenance pemetrexed exposure after inverse probability of treatment weighting (IPTW). Results: Median induction pembrolizumab and pemetrexed durations were 5.1 and 4.2 months. Among patients continuing pembrolizumab after induction, 64% received maintenance pemetrexed. Common discontinuation reasons for induction pemetrexed were completion of planned therapy (79%) and partial response (68%) and progressive disease (38%) and toxicity (29%) for maintenance pemetrexed. After IPTW, median overall survival and real-world progression-free survival were longer in patients continuing pembrolizumab with versus without maintenance pemetrexed (20.3 vs 12.0 months and 10.3 vs 5.8 months, respectively). Conclusion: Patient characteristics and planned treatment decisions affect maintenance pemetrexed utilization in the community oncology setting.

What is this summary about? Pembrolizumab is a drug that helps the lung cancer patient's immune system fight the cancer, even after the cancer has spread, or metastasized. After the patient gets better, the patient is treated with chemotherapy so the cancer will not come back. This is called 'maintenance treatment'. In KEYNOTE-189, a clinical trial, patients lived longer if they had pembrolizumab added to pemetrexed and platinum, which are chemotherapy drugs. If patients had maintenance treatment with pembrolizumab and pemetrexed, they also lived longer. However, do patients in community practices get those treatments? What were the results? We found that at cancer practices in the community instead of clinical trials, not all patients received pemetrexed in maintenance treatment. Many had finished their planned therapy and their tumors had shrunk. Also, some physicians chose not to give their patients pemetrexed. In addition, some women and some older and sicker patients did not get pemetrexed. Some patients had pemetrexed in maintenance but stopped because their cancer grew worse or because they had side effects. Those patients did not live as long as patients who did have maintenance pemetrexed. What do the results mean? Patients with metastatic non-small-cell lung cancer in the community practice do better on the treatments tested in clinical trials. However, certain patients do not get those treatments. The reasons need to be understood, to make sure that those patients get better treatments.

Real-World Outcomes of Trilaciclib Among Patients with Extensive-Stage Small Cell Lung Cancer Receiving Chemotherapy.

INTRODUCTION: Trilaciclib was recently approved in the USA for reducing chemotherapy-induced myelosuppression (CIM) among adults with extensive-stage small cell lung cancer (ES-SCLC) when administered prior to chemotherapy. There is limited understanding of real-world outcomes of trilaciclib. METHODS: A comprehensive literature review was conducted using a keyword search in the MEDLINE, Embase, and conference abstracts. Additional studies were identified through communications with the authors of relevant studies. Published and unpublished real-world studies of trilaciclib- and comparable non-trilaciclib-treated patients with ES-SCLC were included. Evidence on myelosuppressive hematologic adverse events (HAEs), cytopenia-related healthcare utilization, and other reported outcomes (e.g., hospitalizations, dose reduction, and treatment delay) were synthesized. If feasible, outcomes were compared qualitatively between the trilaciclib and historical reference groups, and between first-line trilaciclib initiators and the overall trilaciclib population. Weighted averages were estimated for selected outcomes using sample size as the weight. RESULTS: The literature search identified five unique studies based on eight records-two included trilaciclib only, two non-trilaciclib only, and one both. In trilaciclib cohorts, the weighted average prevalence of grade ≥ 3 myelosuppressive HAEs in ≥ 1 lineage, ≥ 2 lineages, and all three lineages was 40.5%, 14.5%, and 7.5%, respectively. All rates were numerically lower compared to the historical non-trilaciclib cohorts (58.8%, 28.0%, 13.0% respectively). Cytopenia-related healthcare utilization was also lower in the trilaciclib cohorts. In general, first-line trilaciclib initiators had numerically lower myelosuppressive HAEs and cytopenia-related healthcare utilization than the overall trilaciclib patients. CONCLUSIONS: The existing evidence suggests that trilaciclib may reduce single and multilineage grade ≥ 3 myelosuppressive HAEs and cytopenia-related healthcare utilization among patients with ES-SCLC in the real world. It is a promising new treatment for CIM prevention in ES-SCLC and may bring greater benefits to first-line trilaciclib initiators. Future studies are recommended to further evaluate the real-world effectiveness of trilaciclib.

Burden of chemotherapy-induced myelosuppression among patients with ES-SCLC in US community oncology settings.

Aim: To describe the burden of chemotherapy-induced myelosuppression among chemotherapy-treated patients with extensive-stage small-cell lung cancer (ES-SCLC). Materials & methods: Occurrence of grade ≥3 myelosuppressive hematological adverse events (HAEs), treatment patterns and healthcare resource utilization (HCRU) after chemotherapy initiation were evaluated using data from The US Oncology Network and Non-network clinics (1/1/2015-12/31/2020). Results: Among patients with laboratory values (Network: N = 1,374/1,574; Non-network: N = 661/959), over half-experienced grade ≥3 HAEs after chemotherapy initiation (Network = 56.6%; Non-network = 64.1%), and approximately one-third had grade ≥3 HAEs in at least two lineages (Network = 33.0%; Non-network = 31.3%). Patients with grade ≥3 HAEs had greater dose reductions, treatment delays and HCRU than those without. Conclusion: Myelosuppression is a burden to patients with ES-SCLC treated with chemotherapy and the healthcare system.

Our objective was to describe the burden of myelosuppression, a side effect of chemotherapy that results from damage to blood-forming cells in the bone marrow, among patients with extensive-stage small-cell lung cancer (ES-SCLC). We evaluated the prevalence of myelosuppression, chemotherapy treatment patterns and outpatient healthcare use and costs after chemotherapy initiation using data from The US Oncology Network and Non-network clinics between 1 January 2015 and 31 December 2020. Among patients with laboratory values, which were required to identify myelosuppression events, over half of patients experienced severe myelosuppression-related adverse events in one or more lineages after chemotherapy initiation, and approximately one-third experienced severe myelosuppression-related adverse events in at least two blood cell lineages. Patients with severe myelosuppression-related adverse events had greater dose reductions, treatment delays, and healthcare use and costs than those without. Myelosuppression is a burden to patients with ES-SCLC treated with chemotherapy and the healthcare system. Reduction of chemotherapy-induced myelosuppression has the potential to reduce burden on patients and healthcare organizations.