Extensive-Stage Small Cell Lung Cancer and Chemotherapy-Induced Myelosuppression - Episode 8
Jared Weiss, MD, reacts to new measures that increase patient access and provider reimbursement to trilaciclib for patients with extensive-stage small cell lung cancer.
Jared Weiss, MD: Based on my experience with the trial and in patients since the totality of the published data, I expect trilaciclib to improve the quality of life of my patients who get carboplatin, etoposide, and atezolizumab or topotecan. While these studies were conducted, a new agent was approved, lurbinectedin. We don’t have safety or efficacy data for the use of trilaciclib prior to lurbinectedin, and I won’t be doing that in my clinical practice. But for patients who get carboplatin-etoposide-atezolizumab or patients who get topotecan, I expect an improvement in quality of life, and I expect the treatment to be easier for my staff and me.
Thinking about how trilaciclib will change chemotherapy administration for me, first I’m not going to give anyone primary prophylactic pegfilgrastim anymore. It has more adverse events. And if I give them trilaciclib, I can layer on pegfilgrastim, the latter approach, the reverse approach does not have data. I expect better quality of life in my patients. I expect to have less hassle factor for management of myelosuppressive events. I expect both a priority and as a consequence of myelosuppression, fewer dose reductions in my small cell chemotherapy. Interestingly, it’s not something talked about much, but there’s a notable reduction in alopecia. Some of my patients will appreciate this. But the sum is that I expect to be reducing dose less often.
As far as NCCN [National Cancer Comprehensive Network] Guidelines go, I hadn’t heard a lot of pushback from payers before the NCCN update, but many of my community partners care deeply about what NCCN recommends. This will be impactful for them. Many payers find it impactful. Most payers see themselves as passively following the FDA and NCCN. It should eliminate any last barriers to reimbursement.
Of all the cancers that I treat, small cell is the 1 that I most often treat on an inpatient basis. Small cell sometimes presents to the emergency department with complications of central chest syndrome, compression of central airways and central vessels. Chemotherapy is a powerful maneuver for alleviating those symptoms. Cycle 1 is frequently administered inpatient. Until recently this was a barrier to the administration of trilaciclib. However, recently the Center for Medicare & Medicaid Services, otherwise known as CMS, granted an NTAP, or a new technology add-on payment, for trilaciclib when administered to Medicare beneficiaries in the hospital inpatient setting. This will become effective October 1, 2021. What the NTAP does is provide some additional payment to hospitals above the standard Medicare severity diagnosis-related group payment amount and hospitals can start considering adding trilaciclib to their inpatient formularies so that patients can get the benefits starting at cycle 1 when cycle 1 is inpatient.
Transcript edited for clarity.