Evaluation of White Blood Cell Growth Factor (WBCGF) Use in Metastatic Non-Small Cell Lung Cancer (NSCLC) Patients

ABSTRACT Background Data suggest that chemotherapy regimens administered to NSCLC patients in the metastatic setting is not typically associated with febrile neutropenia rates of 20% or greater, therefore, use of WBCGF in this setting should be minimal. National guidelines recommend reduction of chemotherapy dosing in these patients. Our objective was to evaluate the current US Oncology Network utilization of WBCGF in the metastatic setting to determine current practice and associated costs in this palliative chemotherapy setting. Methods We retrospectively identified metastatic NSCLC patients between 7/2006 and 6/2011 using the US Oncology Network EHR database (iKnowMed™). Secondary diagnoses and clinical trials were excluded. Chemotherapy and WBCGF utilization was determined by the number of patients assigned to a 1st or 2nd+ (and beyond) line of therapy (LOT) during the study period. Results During this timeframe, 10,374 patients (female: 44%; median age 67) diagnosed with metastatic NSCLC were identified. Of these, 3284 patients received WBCGF with chemotherapy; where, 2825 patients (33%) were administered 1st LOT and 459 patients (27%) were administered 2nd+ LOT. When reviewing the chemotherapy regimens assigned (regardless of WBCGF administration), the most commonly utilized regimens were: Carboplatin + Paclitaxel +/- Bevacizumab, Pemetrexed containing regimens, Docetaxel containing regimens, Gemcitabine containing regimens, and Vinorelbine. The average estimated cost for these chemotherapy regimens (Medicare Allowable 1Q2012) is $2589/cycle; the average estimated cost of WBCGF usage in the metastatic setting was $1889/dose (Medicare Allowable 1Q2012). Conclusion The American Society of Clinical Oncology has recently identified two opportunities to reduce the cost of care without adversely affecting outcomes (i.e., ineffective chemotherapy at the end of life; the use of WBCGF in palliative chemotherapy where dose reduction is an option). These intersect in this study of NSCLC. These data indicate there is an opportunity to address 40% of the drug costs of NSCLC by the judicious use of protocols using dose reduction as a strategy. Disclosure J.R. Hoverman: I am a medical director for Innovent Oncology. R. Beveridge: I am EVP, Medical Director for McKesson Specialty Health. All other authors have declared no conflicts of interest.