Role of trilaciclib against chemotherapy-induced myelosuppression: An updated systematic review and meta-analysis.

Abstract

e24158 Background: Trilaciclib, a reversible CDK4/6 inhibitor, is used before chemotherapy to reduce myelosuppression. We conducted an updated systematic review and meta-analysis to quantify its myeloprotective benefits and safety. Methods: We systematically reviewed double-blind, placebo-controlled randomized trials of adults receiving cytotoxic chemotherapy with Trilaciclib administered prior to treatment. Primary outcomes were severe neutropenia (SN), febrile neutropenia (FN), duration of severe neutropenia (DSN), G-CSF Administration, ESA Administration, RBC Transfusion and Platelet Transfusion. Secondary outcomes included Anemia, grade 3/4 anemia, grade 3/4 leukopenia and all cause chemotherapy dose reduction, MAHE, Thrombocytopenia, grade 3/4 thrombocytopenia, leukopenia, neutropenia and grade 3/4 neutropenia, overall safety (TEAEs/SAEs), and antitumor efficacy (PFS, OS, ORR). Pooled effects were summarized with RRs/HRs/MDs and 95% CIs using fixed or random effects as appropriate. Results: Five RCTs (n=642; 322 Trilaciclib, 320 control) were included. Trilaciclib reduced SN (RR 0.18, 95% CI 0.07–0.45) and FN (RR 0.24, 0.09–0.60) and shortened DSN (MD −2.78 days, −4.05 to −1.51). Supportive-care use was lower with Trilaciclib: G-CSF (RR 0.59, 0.42–0.82) and ESAs (RR 0.38, 0.18–0.81). Red-blood-cell transfusions trended lower (RR 0.60, 0.34–1.04), while platelet transfusions were similar (RR 0.86, 0.41–1.80). Overall safety was comparable between groups. We found no clear differences in PFS (HR 0.97, 0.67–1.40), OS (HR 0.97, 0.73–1.28), or ORR (RR 0.92, 0.76–1.12). Sensitivity analyses were broadly consistent; excluding the colorectal-cancer trial suggested a modest PFS benefit (HR 0.80, 0.66–0.97). Conclusions: Trilaciclib consistently eases the hematologic burden of chemotherapy and reduces supportive care needs, without an apparent trade-off in survival or response. Benefits are most robust in extensive-stage small-cell lung cancer; tumor-type heterogeneity warrants cautious extrapolation elsewhere.