LIMITED PROACTIVE MYELOPROTECTION IN EXTENSIVE-STAGE SMALL-CELL LUNG CANCER: REAL-WORLD PATTERNS OF G-CSF USE IN GERMAN STATUTORY HEALTH INSURANCE CLAIMS, 2010-2024
Author(s)
Julian Witte, PhD1, Alena Marie-Christin Zeitler, M.Sc., M.Sc.2, Jana Diekmannshemke, M.Sc.1, Mathias Flume, PhD3, Wolfgang Greiner, PhD4, Andreas Wöhrmann, PhD5.
1VANDAGE, Bielefeld, Germany, 2Vandage GmbH, Bielefeld, Germany, 3GeneAccess GmbH, Dortmund, Germany, 4Bielefeld University, Bielefeld, Germany, 5Pharmacosmos GmbH, Wiesbaden, Germany.
1VANDAGE, Bielefeld, Germany, 2Vandage GmbH, Bielefeld, Germany, 3GeneAccess GmbH, Dortmund, Germany, 4Bielefeld University, Bielefeld, Germany, 5Pharmacosmos GmbH, Wiesbaden, Germany.
OBJECTIVES: Chemotherapy for extensive‑stage small‑cell lung cancer (ES‑SCLC) frequently causes multilineage myelosuppression, encompassing neutropenia, anaemia, and thrombocytopenia. G-CSF acts on the neutrophil lineage only, accelerating granulocyte recovery after chemotherapy-induced marrow injury rather than protecting the marrow beforehand, although it is labelled and guideline-recommended as primary prophylaxis when febrile neutropenia risk is high. Real‑world G‑CSF use in German routine ES‑SCLC care has not been quantified.
METHODS: Adults with ES‑SCLC initiating etoposide/platinum or topotecan were identified in German claims data (GWQ ServicePlus; ~7.8 million; 2010-2024). Cycle‑1 G‑CSF was captured across outpatient and inpatient settings via ATC and day‑level inpatient procedure/reimbursement codes. Timing relative to chemotherapy initiation served as a claims‑based proxy: administration within the SmPC‑consistent post‑chemotherapy window was classified as prophylactic‑pattern, later administration as reactive‑pattern, and earlier documentation as other timing. Proportions were calculated with 95% Wilson confidence intervals; comorbidities were assessed over a 365‑day baseline.
RESULTS: 8,081 patients received etoposide/platinum and 297 received topotecan; median age was approximately 65 years, and baseline comorbidity was common, including COPD in approximately 41% and anaemia in approximately 20%. Any cycle‑1 G‑CSF was documented in 1,206 etoposide/platinum patients (14.9%) and 83 topotecan patients (27.9%); approximately 85% and 72%, respectively, received none. Among all etoposide/platinum patients, prophylactic‑pattern G‑CSF was documented in 1.2% (98/8,081) and reactive‑pattern administration in 10.0% (806/8,081). Patients receiving no cycle‑1 G‑CSF showed documented baseline comorbidity comparable to recipients.
CONCLUSIONS: In a large, representative German cohort, most ES‑SCLC patients received no cycle‑1 G‑CSF, and where it was given, administration predominantly followed the reactive rather than the prophylactic timing pattern. These timing windows are claims‑based proxies and do not establish clinical intent. The low overall uptake, the predominance of reactive timing, and a comparably comorbid untreated group together indicate limited use of proactive, marrow-protective strategies against multilineage chemotherapy-induced myelosuppression in German routine practice.
METHODS: Adults with ES‑SCLC initiating etoposide/platinum or topotecan were identified in German claims data (GWQ ServicePlus; ~7.8 million; 2010-2024). Cycle‑1 G‑CSF was captured across outpatient and inpatient settings via ATC and day‑level inpatient procedure/reimbursement codes. Timing relative to chemotherapy initiation served as a claims‑based proxy: administration within the SmPC‑consistent post‑chemotherapy window was classified as prophylactic‑pattern, later administration as reactive‑pattern, and earlier documentation as other timing. Proportions were calculated with 95% Wilson confidence intervals; comorbidities were assessed over a 365‑day baseline.
RESULTS: 8,081 patients received etoposide/platinum and 297 received topotecan; median age was approximately 65 years, and baseline comorbidity was common, including COPD in approximately 41% and anaemia in approximately 20%. Any cycle‑1 G‑CSF was documented in 1,206 etoposide/platinum patients (14.9%) and 83 topotecan patients (27.9%); approximately 85% and 72%, respectively, received none. Among all etoposide/platinum patients, prophylactic‑pattern G‑CSF was documented in 1.2% (98/8,081) and reactive‑pattern administration in 10.0% (806/8,081). Patients receiving no cycle‑1 G‑CSF showed documented baseline comorbidity comparable to recipients.
CONCLUSIONS: In a large, representative German cohort, most ES‑SCLC patients received no cycle‑1 G‑CSF, and where it was given, administration predominantly followed the reactive rather than the prophylactic timing pattern. These timing windows are claims‑based proxies and do not establish clinical intent. The low overall uptake, the predominance of reactive timing, and a comparably comorbid untreated group together indicate limited use of proactive, marrow-protective strategies against multilineage chemotherapy-induced myelosuppression in German routine practice.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH83
Topic
Epidemiology & Public Health, Medical Technologies, Real World Data & Information Systems
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology