The potential benefits of trilaciclib on blood product utilization and neutropenic fever episodes in small cell lung cancer patients: A propensity-matched cohort study.

Abstract

e20134 Background: Cytotoxic chemotherapy is associated with multilineage myelosuppression, which may lead to life-threatening hematologic complications and treatment delays. Trilaciclib, an FDA-approved cyclin-dependent kinase (CDK) 4/6 inhibitor, preemptively mitigates chemotherapy-induced myelosuppression. By transiently arresting CDK4/6-dependent hematopoietic progenitor cells in G1 phase during chemotherapy exposure, trilaciclib protects the bone marrow from cytotoxicity. Trilaciclib is currently approved for use in extensive-stage small-cell lung cancer, with studies examining its role in other tumor types underway. To date, there is limited real-world data on clinical outcomes with trilaciclib. We present a retrospective database analysis examining the effect of trilaciclib on the number of neutropenic fever episodes and transfusions required among small-cell lung cancer patients. Methods: This global population-based retrospective cohort study was designed utilizing the TriNetX Global Collaborative network as the source of patient data and following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Two patient cohorts were created by utilizing ICD-10, RxNorm, and HCPCS codes. All patients had small-cell lung cancer and received cisplatin and etoposide. One cohort was treated with trilaciclib while the other was not. The cohorts were then balanced by propensity score matching and the greedy nearest neighbor algorithm for age, race, and gender, resulting in 156 patients in each arm. They were then compared for the 3-month outcomes of blood product transfusion and neutropenic fever episodes. A 3-month time frame was chosen to correspond with the minimum four cycles of chemotherapy administered for this malignancy. Results: Trilaciclib usage decreased the number of patients requiring transfusion by almost 40% but did not achieve statistical significance, likely due to the low numbers of patients available for analysis (RR 0.61, 95% CI (0.33,1.14), P value 0.12). The number of patients experiencing neutropenic fever was comparable (RR 0.91, 95% CI (0.40,2.08), P value 0.82), but the patients in the trilaciclib arm experienced half as many episodes (mean 1.0 vs 2.1). Conclusions: These results indicate that among patients with extensive-stage small cell lung cancer, trilaciclib use trends towards decreased transfusions and fewer neutropenic episodes per patient. While our data were not statistically significant, likely due to the small pool of patients available for analysis, these results are clinically promising. Additional studies with larger populations can help to confirm our findings.