CHAPTER 1: COSELA HAS HELPED IMPROVE MY PATIENT CARE IN ES-SCLC

Sujith Kalmadi, MD (00:01)

I'm Sujith Kalmadi. I run...I'm part of Ironwood Cancer Center. I've been there for about 12 years. I'm the Chief Medical Officer of this company. We're physician-owned, about 42 medical oncologists, 70 oncology-related physicians, the largest private practice in Phoenix, Arizona.

So, I usually tell my patients that using this proactively will reduce your myelosuppression-related side effects.

I'm now more confident going in and telling them that we can prevent some of your side effects, and the journey hopefully will be better from that standpoint.

NARRATOR

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adultpatients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

CHAPTER 2: COSELA IS MY STANDARD OF CARE

Sujith Kalmadi, MD (00:55)

So, we offer it to all our extensive-stage small cell lung cancer patients on frontline and second line.

I offer it to everybody who's going through that treatment because it's a tough disease. You don't see the complications until it's too late.

By the time you decide is this patient a gold standard or not, the complications could already have happened.

So, based on the data I have, I offer it to everybody.

CHAPTER 3: WHY CHANGE THE APPROACH TO ADDRESSING MYELOSUPPRESSION?

Sujith Kalmadi, MD (01:14)

I think that the mechanism of action is very unique. I like the fact that it works in all three cell lines. It's given proactively, so it reduces the neutropenic complications. Plus (it's) the only drug on the market now for thrombocytopenia prevention in patients with cancer, so I think all of those led me to use it.

And I think in my own opinion, I'm able to get more patients onto second-line treatment, because they're spared the harsh side effects of the frontline. Their performance status is better maintained when they don't have anemia. Their fatigue is lower. So, that helps me to get them ontosecond line, which is where the real benefit is.

I think reduction, and I would say, postponement of treatment used to be a common occurrence, so that has reduced quite a bit. Reduction in doses used to be another thing which we have been able to prevent, and then the reduction in transfusions is obviously a welcome change.

So I think it's been a very welcome addition to my armamentarium. It has reduced my side effect management a little bit. Helps with the logistics of the practice where patients don't have to be rescheduled because there's a significant impact on the chair time when you re-change a patient from one week to the next, or one week to the next two days, the whole scheduling gets impacted, so logistically it's a big change, big welcome addition to the nurses so that they don't have to go through that.

CHAPTER 4: PATIENT REPORTED OUTCOMES IN STUDIES MATTER

Sujith Kalmadi, MD (02:30)

So for me, the patient-related outcomes is very important.

Fatigue always is a concern because it can change a patient's expectations as to what they can do and not do, so improving their fatigue is very important.

Some of my patients are worried about low counts delaying their treatments and having to get their loved ones to bring them back and forth for the treatments and sometimes transfusions, so definitely myelosuppression-related count issues have impacted the quality of life for patients there.

So really, it's how the patient feels. That's really what helps me decide, should I be using this drug or not?

I do look at the patient-reported outcomes in the setting of a randomized trial. There you can compare meaningful numbers and make sure that, you know, what's the effect on the quality of life? What's the effect on their relationships? Those kind of things.

CHAPTER 5: DISCUSSING COSELA SAFETY

Sujith Kalmadi, MD (03:19)

It looks very safe, and in our practice, we have a unique practice where we have central lines on all our patients, usually a port, rarely a PICC line, so the infusion-related reaction such as phlebitis is- is a non-event for us in our own practice. The rest of the abnormalities are fairly easy to manage.

CHAPTER 6: WHAT I TELL MY PATIENTS AND PEERS ABOUT COSELA

Sujith Kalmadi, MD (03:40)

So, I usually tell my patients that, you know, using this proactively will reduce your, myelosuppression-related side effects.

And to my peers, I tell them we have a novel therapy which improves myelosuppression in extensive-stage small cell lung cancer with a very tolerable safety profile.

IMPORTANT SAFETY INFORMATION

NARRATOR (3:58)

CONTRAINDICATION

• COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

WARNINGS AND PRECAUTIONS

Injection-Site Reactions, Including Phlebitis and Thrombophlebitis

• COSELA administration can cause injection-site reactions, including phlebitis and thrombophlebitis, which occurred in 56 (21%) of 272 patients receiving COSELA in clinical trials, including Grade 2 (10%) and Grade 3 (0.4%) adverse reactions. Monitor patients for signs and symptoms of injection-site reactions, including infusion-site pain and erythema during infusion. For mild (Grade 1) to moderate (Grade 2) injection-site reactions, flush line/cannula with at least 20 mL of sterile 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP after end of infusion. For severe (Grade 3) or life-threatening (Grade 4) injection-site reactions, stop infusion and permanently discontinue COSELA. Injection-site reactions led to discontinuation of treatment in 3 (1%) of the 272 patients.

Acute Drug Hypersensitivity Reactions

• COSELA administration can cause acute drug hypersensitivity reactions, which occurred in 16 (6%) of 272 patients receiving COSELA in clinical trials, including Grade 2 reactions (2%). Monitor patients for signs and symptoms of acute drug hypersensitivity reactions. For moderate (Grade 2) acute drug hypersensitivity reactions, stop infusion and hold COSELA until the adverse reaction recovers to Grade ≤1. For severe (Grade 3) or life-threatening (Grade 4) acute drug hypersensitivity reactions, stop infusion and permanently discontinue COSELA.

Interstitial Lung Disease/Pneumonitis

• Severe, life-threatening, or fatal interstitial lung disease (ILD) and/or pneumonitis can occur in patients treated with cyclin-dependent kinases (CDK)4/6 inhibitors, including COSELA, with which it occurred in 1 (0.4%) of 272 patients receiving COSELA in clinical trials. Monitor patients for pulmonary symptoms of ILD/pneumonitis. For recurrent moderate (Grade 2) ILD/pneumonitis, and severe (Grade 3) or life-threatening (Grade 4) ILD/pneumonitis, permanently discontinue COSELA.

Embryo-Fetal Toxicity

• Based on its mechanism of action, COSELA can cause fetal harm when administered to a pregnant woman. Females of reproductive potential should use an effective method of contraception during treatment with COSELA and for at least 3 weeks after the final dose.

ADVERSE REACTIONS

• Serious adverse reactions occurred in 30% of patients receiving COSELA. Serious adverse reactions reported in >3% of patients who received COSELA included respiratory failure, hemorrhage, and thrombosis.
• Fatal adverse reactions were observed in 5% of patients receiving COSELA. Fatal adverse reactions for patients receiving COSELA included pneumonia (2%), respiratory failure (2%), acute respiratory failure (<1%), hemoptysis (<1%), and cerebrovascular accident (<1%).
• Permanent discontinuation due to an adverse reaction occurred in 9% of patients who received COSELA. Adverse reactions leading to permanent discontinuation of any study treatment for patients receiving COSELA included pneumonia (2%), asthenia (2%), injection-site reaction, thrombocytopenia, cerebrovascular accident, ischemic stroke, infusion-related reaction, respiratory failure, and myositis (<1% each).
• Infusion interruptions due to an adverse reaction occurred in 4.1% of patients who received COSELA.
• The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

DRUG INTERACTIONS

• COSELA is an inhibitor of OCT2, MATE1, and MATE-2K. Co-administration of COSELA may increase the concentration or net accumulation of OCT2, MATE1, and MATE-2K substrates in the kidney (e.g., dofetilide, dalfampridine, and cisplatin).

To report suspected adverse reactions, contact Pharmacosmos Therapeutics at 1-888-828-0655 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

This information is not comprehensive. Please see full Prescribing Information at COSELA.com

CHAPTER 1: COSELA: MY STANDARD OF CARE FOR ES-SCLC PATIENTS

Martin Dietrich, MD, PhD (00:01)

Hello. My name is Dr. Martin Dietrich.

I'm a thoracic oncologist and geneticist by training and I see largely a thoracic patient population.

So I think this is a great step forward for our patients, and I think we should extend that benefit to our patients.

NARRATOR

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Martin Dietrich, MD, PhD

So, at my practice, I've adopted COSELA to be included in every regimen for small cell lung cancer patients in combination with a platinum-based regimen with immunotherapy in the first-line setting, and also in the subsequent line therapy in combination with topotecan.

Small cell lung cancer is a very difficult to treat disease. From the very first day, to the very last treatment option, we are dependent on chemotherapy. We have very limited impact of immunotherapy, some but not much, and we don't have any targeted therapy options at the current time.

So for us, it's important that a patient's course in first and later line setting is protected to the best extent possible, and this makes the medication, in my opinion, a standard of care that is applicable to every patient, and allows us to deliver the chemotherapy in the most controlled way possible.

CHAPTER 2: COSELA HAS HELPED IMPROVE MY PATIENT CARE

Martin Dietrich, MD, PhD (01:35)

The mechanism of action for COSELA is a novel mechanism of action for the protection of the bone marrow microenvironment.

Well, this is a new mechanism of action that protects not only one but multiple lines of cells from the bone marrow.

So, for us, it allows to prevent a lot of the foreseeable complications of chemotherapy application in the setting of small cell lung cancer, by being able to protect good cells and saving patients’ time, for supportive care, time in the hospital for transfusions, and is, overall… our experience is that complications and, I want to say, management needs for patients are actually improving… not only from a provider side but also from a patient side. So, it's a, it's a mutual win for us to avoid those complications.

CHAPTER 3: ALL ES-SCLC PATIENTS FACE RISK OF MYELOSUPPRESSION DURING CHEMOTHERAPY

Martin Dietrich, MD, PhD (02:25)

This is really a problem that affects all patients. There is not a patient that I could exclude upfront, where I would say, "This is a patient that is not at risk of myelotoxicity."

I think it's very easy to explain for a patient that we're giving medications up front, so that, we avoid the complications that are expectedly occurring with chemotherapy, and I believe that patients are very understanding of this and actually very appreciative that we're trying to keep them safe, and I think that's a main reason why we're using COSELA up front, so that we don't put a patient at risk, and waiting for things to go out of range before we start intervening on their behalf.

I believe protecting the stem cell pool from the first cycle of therapy onwards, is highly beneficial, not only to have an immediate cycle-dependent effect, but also to avoid some of the cumulative toxicities.

CHAPTER 4: THE PATIENT’S EXPERIENCE MATTERS

Martin Dietrich, MD, PhD (03:20)

So, patient-reported outcomes have grown significantly in our assessment, and for the longest time, they were not even included in clinical trial designs, and now, they're almost mandatory. We are shifting our perspective, not only for the classical measures of survival, but we're going, I want to say, more subjective measures of patient experience. Trying to design a path for patients where they can receive active treatment whilst maintaining quality of life.

For me, a drug that improves the patient's experience is already worthwhile.

CHAPTER 5: COSELA HELPS ADDRESS A NEED FOR MY PATIENTS

Martin Dietrich, MD, PhD (03:54)

Counts have consequences is one of the first lessons, that you learn as an oncology fellow.

I believe that one of the most unaddressed needs was myelosuppression and COSELA has provided us with an answer, that was at a very molecular level, intervening and preventing these complications instead of forcing our hands to reactively intervene and treat patients.

I do like that it results in a better course of, of treatment with less bumps in the road.

IMPORTANT SAFETY INFORMATION

NARRATOR (4:29)

CONTRAINDICATION

• COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

WARNINGS AND PRECAUTIONS

Injection-Site Reactions, Including Phlebitis and Thrombophlebitis

• COSELA administration can cause injection-site reactions, including phlebitis and thrombophlebitis, which occurred in 56 (21%) of 272 patients receiving COSELA in clinical trials, including Grade 2 (10%) and Grade 3 (0.4%) adverse reactions. Monitor patients for signs and symptoms of injection-site reactions, including infusion-site pain and erythema during infusion. For mild (Grade 1) to moderate (Grade 2) injection-site reactions, flush line/cannula with at least 20 mL of sterile 0.9% Sodium Chloride Injection, USP or 5% Dextrose Injection, USP after end of infusion. For severe (Grade 3) or life-threatening (Grade 4) injection-site reactions, stop infusion and permanently discontinue COSELA. Injection-site reactions led to discontinuation of treatment in 3 (1%) of the 272 patients.

Acute Drug Hypersensitivity Reactions

• COSELA administration can cause acute drug hypersensitivity reactions, which occurred in 16 (6%) of 272 patients receiving COSELA in clinical trials, including Grade 2 reactions (2%). Monitor patients for signs and symptoms of acute drug hypersensitivity reactions. For moderate (Grade 2) acute drug hypersensitivity reactions, stop infusion and hold COSELA until the adverse reaction recovers to Grade ≤1. For severe (Grade 3) or life-threatening (Grade 4) acute drug hypersensitivity reactions, stop infusion and permanently discontinue COSELA.

Interstitial Lung Disease/Pneumonitis

• Severe, life-threatening, or fatal interstitial lung disease (ILD) and/or pneumonitis can occur in patients treated with cyclin-dependent kinases (CDK)4/6 inhibitors, including COSELA, with which it occurred in 1 (0.4%) of 272 patients receiving COSELA in clinical trials. Monitor patients for pulmonary symptoms of ILD/pneumonitis. For recurrent moderate (Grade 2) ILD/pneumonitis, and severe (Grade 3) or life-threatening (Grade 4) ILD/pneumonitis, permanently discontinue COSELA.

Embryo-Fetal Toxicity

• Based on its mechanism of action, COSELA can cause fetal harm when administered to a pregnant woman. Females of reproductive potential should use an effective method of contraception during treatment with COSELA and for at least 3 weeks after the final dose.

ADVERSE REACTIONS

• Serious adverse reactions occurred in 30% of patients receiving COSELA. Serious adverse reactions reported in >3% of patients who received COSELA included respiratory failure, hemorrhage, and thrombosis.
• Fatal adverse reactions were observed in 5% of patients receiving COSELA. Fatal adverse reactions for patients receiving COSELA included pneumonia (2%), respiratory failure (2%), acute respiratory failure (<1%), hemoptysis (<1%), and cerebrovascular accident (<1%).
• Permanent discontinuation due to an adverse reaction occurred in 9% of patients who received COSELA. Adverse reactions leading to permanent discontinuation of any study treatment for patients receiving COSELA included pneumonia (2%), asthenia (2%), injection-site reaction, thrombocytopenia, cerebrovascular accident, ischemic stroke, infusion-related reaction, respiratory failure, and myositis (<1% each).
• Infusion interruptions due to an adverse reaction occurred in 4.1% of patients who received COSELA.
• The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

DRUG INTERACTIONS

• COSELA is an inhibitor of OCT2, MATE1, and MATE-2K. Co-administration of COSELA may increase the concentration or net accumulation of OCT2, MATE1, and MATE-2K substrates in the kidney (e.g., dofetilide, dalfampridine, and cisplatin).

To report suspected adverse reactions, contact Pharmacosmos Therapeutics at 1-888-828-0655 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

This information is not comprehensive. Please see full Prescribing Information at COSELA.com

IMPROVING MY ES-SCLC PATIENTS’ EXPERIENCE

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

So extensive-stage small cell lung cancer is a really dismal disease and those patients usually have a very poor prognosis.

And so, my goal is for the patient experience, as well as the family experience, to be better, for those patients to live as long as possible, to be as healthy as possible, and to enjoy their time.

For me, COSELA is now a standard of care. When I look at the data, I can't imagine not giving my patients the opportunity that COSELA affords, for them to stay on therapy, at the prescribed doses, and to stay on schedule. I feel like that's the fair thing to do for my patient, and so, for me, it's a standard.

Most patients are excited about it when I tell them the benefits of using COSELA, especially when they hear that it'll decrease their need for transfusions or delays in their therapy.

As far as keeping our chemotherapy treatments on course, I've done a look back at my patients since I've started using COSELA. And I see less dose reduction and I see less rescheduling, for those patients.

So, it's my experience that I'm, I'm seeing less cytopenia and I'm having less transfusions since starting COSELA for my small cell patients.

NARRATOR

IMPORTANT SAFETY INFORMATION

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

A NOVEL APPROACH TO MULTILINEAGE RISKS

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

At least 30 to 40% of the time, you get multilineage involvement with cytopenia. So, there can be neutropenia with anemia and thrombocytopenia. So, you'll see multilineage effect often.

The multilineage aspect of COSELA is really what excites me. So, when you're giving COSELA, one treatment that's taking care of the cell lineages is immensely important.

I think the reduction in red blood cell transfusion is one of the most important components to me. Obviously, the neutrophils are very important, but you can treat those without hospitalizing the patient sometimes. But a lot of times, when they're really symptomatic with their anemia, you have to hospitalize them. And so the reduction in red blood cell transfusion is very important for me.

So, when we look at the COSELA data, we see a reduction in thrombocytopenia from 37% to 2%, and when we reduce that thrombocytopenia, actually it's the best thing for the patient, as well as for me. It's a win for me, too.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

LOW BLOOD CELL COUNTS IMPACT PATIENTS’ LIVES

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

The low blood counts affect the patients in various ways. Obviously, these patients were mostly smokers, and so they have lung diseases like COPD and emphysema.

So, when they're short of breath and they don't have enough red blood cells to carry oxygen, they're symptomatic. And so, they have more fatigue, they end up not able to go out and do the things that they really enjoy doing.

One of my patients came in and was like, "I'm just not able to do my grocery shopping anymore." And for her, this is a big deal, you know. She has grandchildren that come over to visit and now she doesn't have food that she normally has to prepare for them. So, it doesn't seem like much, but it's actually a huge deal for this particular patient.

In addition to that, infections that come along with low white blood cell counts put patients at risk. They don't want to go out to do their normal social activities, especially now. You know, "I would go to church," or, "I would go to the mall, but I don't want to be in a crowd, because I know my white blood cell count is very low." So, the patient experience really is affected by low blood counts.

My dad had small cell lung cancer, and there were things that we just didn't get to do. But there were times when he felt well and I was able to put him in my car and take him for a drive. And it doesn't seem like much, but in that last six months of his life, that's what I remember.

And so, not just for me but for my patients and for their families, I want them to have experiences that, even though the patient may succumb to the disease ultimately, that patient's family is left with memorable, you know, kind of time spent and very valuable time. And for myself personally, it means everything. So, I can't imagine what it means for my patients and their families.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

TREATMENT DELAYS IMPACT PATIENTS AND PRACTICES

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

Routine is for patients, very important to me because we're dealing with cancer and patients feel like things are out of their control. So, let's control as much as we can.

Myelosuppression can be a big deal. Things that matter to patients are that, "I get my therapy," and, "I get my therapy on time." And what happens with myelosuppression is it delays therapy. It also reduces the amount of therapy that patients can tolerate.

It means that there's time off therapy, the disease is growing. We know that it's a rapidly dividing cancer cell, cancer type. And so, those patients, when they're off therapy, they experience not only the mental kind of angst of wanting therapy and not getting it and knowing that the disease is growing, but in addition to that, the disease actually grows.

It's post-COVID time now, we have limited nursing staff, and the chair time for each patient to receive their chemotherapy is very valuable. So, when we have to delay therapy, we have to figure out the schedule again, and make sure we have nursing coverage, make sure that drugs are going to be available in the time that the patient's going to be in the infusion suite.

And all of that, a lot of work goes into that scheduling. And sometimes, it's underappreciated until you run into times like now, where the scheduling is limited.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

AFTER DECADES, ES-SCLC CARE IS CHANGING

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

We talked about being reactive when it comes to the bone marrow for those patients. And that's been the standard of care, it's been what we've done for decades. And we know that for three or four decades, the standard of care for small cell lung cancer didn't change at all, whether it's supportive care medications or the actual drugs that we're using to treat the disease.

So now we have different ways to approach small cell lung cancer. We're including immune checkpoint inhibitors, and now, with COSELA, we can be proactive about preserving a patient's bone marrow and getting them through therapy without having kind of devastating cytopenias.

So, I will talk to my peers and my colleagues about their approach, and just remind them that being reactive sometimes is too late, and if you can save that patient from ending up in a situation like hospitalized with febrile neutropenia, or delaying their therapy, by being proactive with COSELA, it's a different way and it's, you know, something to seriously be considered.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

ASSESSING MYELOSUPPRESSION RISKS FOR ES-SCLC PATIENTS

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

So, we give chemotherapy and we don't really know what's going to happen. Each patient has a different reaction to chemotherapy, whether it's side effects, whether it's just fatigue. Some patients get anemic or cytopenic. And if you can't predict that, then it's hard to make a routine.

COSELA is a way to level the playing field. We have chemotherapy that we're going to give to patients, and we can't really predict how they're going to respond, particularly how the bone marrow is going to respond. And we need to protect that bone marrow, because it's going to be responsible for repopulating those cells after that patient's treated for their, for their disease.

And if we can protect the stem cells using COSELA, then we can help to keep the patient on therapy, keep them at the regular doses and not have to reduce doses.

I've had some patients with small cell lung cancer who get chemotherapy and we react, because that's historically what we did and those patients, unfortunately, are already in a downward spiral.

I've had a patient he became neutropenic. And there was no recovering from it.

So, when you're proactive about approaching myelosuppression, you keep the patients from ending up in compromising situations.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

TREATMENT DELAYS IMPACT PATIENTS AND PRACTICES

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Jason Porter, MD

Routine is for patients, very important to me because we're dealing with cancer and patients feel like things are out of their control. So, let's control as much as we can.

Myelosuppression can be a big deal. Things that matter to patients are that, "I get my therapy," and, "I get my therapy on time." And what happens with myelosuppression is it delays therapy. It also reduces the amount of therapy that patients can tolerate.

It means that there's time off therapy, the disease is growing. We know that it’s a rapidly dividing cancer cell, cancer type. And so, those patients, when they're off therapy, they experience not only the mental kind of angst of wanting therapy and not getting it and knowing that the disease is growing, but in addition to that, the disease actually grows.

It's post-COVID time now, we have limited nursing staff, and the chair time for each patient to receive their chemotherapy is very valuable. So, when we have to delay therapy, we have to figure out the schedule again, and make sure we have nursing coverage, make sure that drugs are going to be available in the time that the patient's going to be in the infusion suite.

And all of that, a lot of work goes into that scheduling. And sometimes, it's underappreciated until you run into times like now, where the scheduling is limited.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

PATIENTS FEEL THE IMPACT OF LOW BLOOD CELL COUNTS

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Monica Tripodi, APRN, MSN, FNP-C, AOCNP

So myelosuppression, a lot of complications with that would be you know if their white blood cell count becomes too low and they develop a fever and they end up being hospitalized, which is a burden on them and it's a burden on their loved ones because I'm sure it’s, well I know it's really scary to go through that.

Or if their platelet count becomes too low and they become having bleeding issues or even just feeling really fatigued from their red blood cell count being so low. They feel all that through myelosuppression and it just makes their symptoms a lot worse. It just makes them feel really tired through treatment and it keeps them from doing the things that they want to do. They just don't have the energy for it.

So really once they have extensive-stage lung cancer, our goal is just to help them achieve all that they're wanting to do within the last amount of time that they have. If they want to be able to attend that grandson's wedding or the daughter's graduation, we want them to be able to achieve all of those things. And I feel that through treatment we're able to keep a lot of their symptoms from their disease at bay and we're able to keep their symptoms at a state to where they're able to live as full of a life as they're able to.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

STAYING ON PLAN IS IMPORTANT TO PATIENTS

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Monica Tripodi, APRN, MSN, FNP-C, AOCNP

The patients are always sad and a little disheartened when they have to have a delay in treatment because they know that a delay in treatment means that those cancer cells are able to grow and that there's always the possibility that the cancer could spread.

It can be overwhelming because you feel like you're letting the patient down. A lot of times their family members are with them and they even know that every time we look at a treatment delay, every time we look at a dosage reduction, that we're giving the cancer time to grow and possibly spread, which means more symptoms, possibly worsening shortness of breath, a lot of the symptoms that come with the lung cancer.

So proceeding as planned for the patient means that they can meet the goals that they have planned for themselves on their calendar, which of course they're writing down wedding days, graduation days, milestones that they're wanting to meet, the whole reason why they're going through these therapies. So what this means for the patient is that they don't have to delay their treatment.

Cycle delays for our practice just means more appointments for lab draws, which affect the staff and affect the wait time of the other patients. So when you're taking up more chair time, it means other patients that were scheduled to receive treatment may have to wait.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

BEING PROACTIVE AND PROTECTIVE

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Monica Tripodi, APRN, MSN, FNP-C, AOCNP

Being proactive means that we are being more protective of our patients.

So when we first heard of COSELA, we wanted to try it in some of our more extensive-stage small cell lung cancer patients, because their chemotherapy regimen is really hard and a lot of them have already seen chemotherapy regimens prior to what we have them on now, and their bone marrow is just very tired is what we like to say. So we tried using this on several of our patients and we were able to proceed with treatments without delays, which is almost unheard of in some of these really myelosuppressive regimens.

With COSELA, it protects all of the cells. So we're helping the patients’ red blood cells, white blood cells, platelets as we're giving this medication prior to their chemotherapy. That way their cells stay up enough to where we don't have to delay treatment, we can proceed as we have planned, as the patient has planned.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

MY STANDARD OF CARE FOR ES-SCLC PATIENTS

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Monica Tripodi, APRN, MSN, FNP-C, AOCNP

So initially we tried COSELA on a few of our patients that had come in with metastatic small cell lung cancer. And what we saw was we weren't having to delay treatment, we weren't having to dose reduce, and this was really working. And now it's become more of a standard of care to where when we know these patients are about to start treatment, we add it on up front. We don't wait to watch for the myelosuppression because we know what's going to happen.

So by using COSELA and helping to protect these three cell lineages, we're helping to avoid treatment delays, we're helping to avoid dosage reductions, which ultimately means that they're not having as many side effects, and they're tolerating treatment well and they're still able to go on family trips, to go on family vacations, and to really reach those goals that they've set for themselves in life.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com

INCORPORATING COSELA INTO THE PRACTICE WAS SIMPLE

NARRATOR (00:09)

COSELA is indicated to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for ES-SCLC.

Monica Tripodi, APRN, MSN, FNP-C, AOCNP

Incorporating COSELA into our practice was very smooth. It only adds about 30 minutes of chair time, and it's such a great experience for the patients because they feel more confident in receiving the chemotherapy because we've already previously discussed with the patient why we're doing it, and that it's really there to help protect them so that they can continue with their treatment goals.

So the process of including COSELA in our practice was simply adding it to the order set so that when the regimen is ordered, it just automatically populates each time we add that specific regimen.

We now have it to where the infusion nurses are accustomed to giving this medication along with their chemotherapy regimen, and they'll even say, "I see that you're giving this regimen, but I don't see COSELA listed."

And so they'll even know to come and ask me or the oncologist, "I don't see COSELA. Is this something that you want to add?" And so that way they act as a double-checking system.

NARRATOR

Important Safety Information:

COSELA is contraindicated in patients with a history of serious hypersensitivity reactions to trilaciclib.

Warnings and precautions include injection-site reactions (including phlebitis and thrombophlebitis), acute drug hypersensitivity reactions, interstitial lung disease (pneumonitis), and embryo-fetal toxicity.

The most common adverse reactions (≥10%) were fatigue, hypocalcemia, hypokalemia, hypophosphatemia, aspartate aminotransferase increased, headache, and pneumonia.

This information is not comprehensive. Please see the full Prescribing Information at COSELA.com