Standard chemotherapy regimens for patients with extensive-stage small cell lung cancer (ES-SCLC) often lead to clinically significant myelosuppression. Chemotherapy-induced myelosuppression (CIM) is associated with increased risk of neutropenia, anemia, and thrombocytopenia; all of which carry other associated risks. Supportive care treatments also have their own costs and risks.
A team of researchers investigated the myeloprotective benefits of the cyclin-dependent kinase 4/6 inhibitor trilaciclib to determine if it might be a feasible option for reducing CIM and the use of supportive care treatments. Their analysis was published in Cancer Medicine.
For this retrospective analysis, the researchers pooled data from 3 independent, multicenter, randomized phase 2 clinical trials that compared the administration of trilaciclib prior to chemotherapy with a placebo. They also sought to determine the effect of trilaciclib on the use of supportive care treatments such as granulocyte colony-stimulating factors (G-CSFs), erythropoiesis-stimulating agents (ESAs), and red blood cell (RBC) and platelet transfusions.
Administering trilaciclib prior to chemotherapy significantly reduced the duration of severe neutropenia during cycle 1, as well as the occurrence of severe neutropenia across cycles 1 to 4. Use of G-CSF was reduced by approximately half in patients who received trilaciclib prior to chemotherapy compared with those who received placebo (28.5% vs 56.3%), the researchers reported. Reduced G-CSF use “has the potential to reduce the burden on healthcare systems, patients, and caregivers,” they noted.
Prechemotherapy administration of trilaciclib also significantly reduced the incidence of grade 3/4 anemia in patients with ES-SCLC, compared with placebo. Both ESA administration and RBC transfusions on or after week 5 were significantly reduced in these patients (3.3% and 14.6%, respectively), compared with patients who received placebo (11.8% and 26.1%, respectively). This could potentially reduce the burden of anemia on patients and help to conserve limited blood supplies.
All in all, the data show trilaciclib prior to chemotherapy is beneficial in patients with ES-SCLC, and may save money by reducing the need for supportive care measures and hospital admissions that might arise as a result. It could also improve quality of life for patients undergoing chemotherapy for ES-SCLC.
“By improving key myelosuppressive endpoints and reducing the need for associated supportive care, trilaciclib has the potential to reduce both the societal and economic burden of CIM,” the researchers concluded.
Disclosure: The authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ferrarotto R, Anderson I, Medgyasszay B, et al. Trilaciclib prior to chemotherapy reduces the usage of supportive care interventions for chemotherapy-induced myelosuppression in patients with small cell lung cancer: pooled analysis of three randomized phase 2 trials. Cancer Med. 2021;10(17):5748-5756. doi:10.1002/cam4.4089