Can Trilaciclib Help Prevent Hematological Adverse Events With Chemotherapy in Patients With SCLC?

Trilaciclib, a drug approved for patients with extensive-stage small cell lung cancer (SCLC), has “consistently demonstrated efficacy” in reducing chemotherapy-induced myelosuppression (CIM), according to a recent study.

Nitya Batra, MBBS, of the Corewell Health William Beaumont University Hospital, and colleagues presented findings from the meta-analysis at the 2024 American Society of Clinical Oncology Annual Meeting.

Trilaciclib, which is a CDK4 and CDK6 inhibitor, is the only agent approved by the US Food and Drug Administration that “preemptively protects hematopoietic stem cells from CIM without compromising efficacy,” according to the researchers. Dr. Batra and colleagues explained that it was important to evaluate the preventive effect of trilaciclib through a combined meta-analysis of clinical trials and retrospective studies because “limited real-world evidence of its efficacy exists owing to its recent approval.”

Dr. Batra and colleagues conducted a systematic literature search on PubMed, Embase, Cochrane, and Scopus from inception of the systems until December 2023. They identified and included 3 real-world, retrospective, cohort studies and 4 randomized, controlled trials with trilaciclib and non-trilaciclib arms.

The studies comprised 6537 patients with extensive SCLC or locally recurrent or metastatic breast cancer. The mean patient age was 63.28 years, and 49.21% of patients were male. The  chemotherapy regimens received by patients with SCLC included the combination of etoposide/platinum (E/P), E/P/PD-L1 inhibitors, or topotecan. Patients with breast cancer received gemcitabine/carboplatin.

The primary outcome of the analysis was CIM-related grade ≥3 hematological adverse events, and the secondary outcomes included supportive care interventions to remedy CIM. The researchers used a random-effects model to conduct quantitative meta-analyses of the study data.

The study showed that there was a reduced incidence of febrile neutropenia in patients who received trilaciclib (2.41%) compared with those who did not (7.56%; odds ratio [OR], 0.35). Patients who received trilaciclib also showed lower rates of severe neutropenia (21.76% vs 41.91%; OR, 0.57), anemia (18.02% vs 32.41%; OR, 0.51), and thrombocytopenia (20.06% vs 31.25%; OR, 0.62).

In addition, patients who received trilaciclib showed a significantly lower use of cytopenia-supportive therapies such as granulocyte colony-stimulating factor (40.47% vs 81.01%; OR, 0.61) and red blood cell transfusions (16.66% vs 18.25%; OR, 0.59) than those who did not receive it.

The overall response rates and overall survival rates were “similar” between patients who did and did not receive trilaciclib, but progression-free survival was “noted to be longer” in the patients receiving trilaciclib.

Dr. Batra and colleagues concluded by outlining the findings of the meta-analysis, clinical implications of the data, and avenues for future research on the drug.

“Trilaciclib use consistently demonstrated efficacy in reducing CIM, thus lowering cytopenia-related health care utilization without compromising treatment efficacy in trials and real-world settings,” they concluded. “Its novel mechanism of action offers great promise, and further studies with larger sample sizes on various cancers will corroborate existing evidence.”

Reference

Batra N, Khosla AA, Shrestha AB, et al. Trilaciclib use for prevention of hematological adverse events in chemotherapy: a meta-analysis of real-world studies and clinical trials. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024; Chicago, Illinois.