The Role of Supportive Care in the Management of Myelosuppression in Patients With SCLC

Transcript:
Jorge Nieva, MD: How have approaches to myelosuppression evolved in recent years, especially in extensive stage, small cell lung cancer?

Ashish Saxena, MD, PhD: We were, typically and historically, treating it the way we do in other tumor types with G-CSF [granulocyte colony stimulating factor], sometimes prophylactically, but a lot of times playing catch up, where when people got to anemic or thrombocytopenic, you may have to give them platelet transfusions. There has been use of things like erythropoietin stimulating agents for anemia, and thrombopoietin receptor agonists for thrombocytopenia, but then we're sort of doing something for each line of blood cells. Then again, as I said, doing transfusions, but more recently with drugs, specifically, trilaciclib, which is CDK4 inhibitor, that when given appropriately before each dose of the chemotherapy transiently arrests hematopoietic stem cells and progenitor cells, to protect them from the effects of chemotherapy. That's become now FDA approved to help prevent myelosuppression induced by chemotherapy. That's been the more recent development in this. We are wondering what you think of as the role of supportive care in myelosuppression, particularly in light of things like shortages for blood products, like platelets and red blood cells?

Jorge Nieva, MD: I think we need to be good stewards of resources, and that includes our blood resources. To the extent that we can make sure that our patients have as little impact from myelosuppression as possible, have as few transfusions as possible. That goes a long way to ensuring that our patients can have the best outcomes.

Ashish Saxena, MD, PhD: Absolutely.

Jorge Nieva, MD: A recent study that aimed to characterize the population pharmacokinetics of trilaciclib found that its use resulted in optimal myeloprotective effects with no impact on the antitumor effects of chemotherapy. In light of these findings, and others, demonstrating the utility of cyclin- dependent kinase 4/6 inhibition [CDK4/6], how do you incorporate supportive care into practice? And what are some of the practical considerations of its use?

Ashish Saxena, MD, PhD: As you said, we really want to help the patients with supportive care and protection from myelosuppression, because it does translate into them feeling better. I use trilaciclib in our practice. We use it the way it's supposed to be given before chemotherapy, so we have built it into our practice, as we give patients antinausea medicines before they get chemo or fluids in for certain chemotherapy regimens. We use trilaciclib, and giving it the right way, remembering to give it with each dose of the chemotherapy, is important. We’re also educating the patients, since sometimes they don't even realize they're getting it, because for them, it's just part of the cocktail before they get their chemotherapy.

Jorge Nieva, MD: Now, that same study showed that higher exposure did increase the probabilities of adverse events, such as headaches, phlebitis, thrombophlebitis, and injection site reactions. When evaluating the use of supportive care, what are some of the factors you consider when it comes to safety and risk-benefit ratio?

Ashish Saxena, MD, PhD: One of the things is that, with your supportive care measures, you don't want to impact the efficacy of the treatment that you're giving, the chemotherapy. Sometimes we worry about certain things, giving them a bit might block the effectiveness of the chemotherapy.There may have been a concern that you're giving a CDK4/6 inhibitor to arrest the blood cells, but maybe it will also protect the cancer cells from the chemotherapy effects. But, as the study you mentioned showed, it didn't seem to do that. That's an important thing. Cost is an important thing. For supportive care, we want it to be costefficient and costbeneficial. Finally, it's supposed to do what we want it to do, which is support the patients. It should help them not have too many side effects from it, but also make them feel better and have good outcomes in terms of supporting their ability to get through the cancer treatments.

Transcript edited for clarity.