Abstract
Trilaciclib (COSELA™) is a transient inhibitor of cyclin-dependent kinases 4 and 6 (CDK 4/6) that is approved in the USA to decrease the incidence of chemotherapy-induced myelosuppression (CIM) when administered before a platinum/etoposide-containing regimen or topotecan-containing regimen in adults being treated for extensive-stage small cell lung cancer (ES-SCLC). It is the first approved therapy to provide myeloprotection, and when administered before chemotherapy, it is a valuable option for decreasing the incidence of CIM. In three clinical randomized trials, trilaciclib administration prior to standard-of-care chemotherapy for ES-SCLC reduced myelosuppression and the need for rescue interventions, improved patient-reported outcomes and the safety profile of the chemotherapy regimens, and had no impact on antitumor efficacy.
Plain Language Summary
As well as destroying cancer cells, chemotherapy also damages healthy, rapidly growing cells in the body, including blood-forming cells in the bone marrow (i.e. bone marrow suppression). This results in low levels of white blood cells (increasing the risk of infection), red blood cells (causing anemia) and platelets (increasing the risk of bleeding). Bone marrow suppression often occurs after treatment with the highly toxic chemotherapies, such as those used in the treatment of extensive-stage small cell lung cancer (ES-SCLC). Trilaciclib (COSELA™) is a drug that transiently protects the white and red blood cells and platelets from chemotherapy damage during treatment. When administered before chemotherapy, trilaciclib reduces the incidence of chemotherapy-induced bone marrow suppression. After treatment with trilaciclib and chemotherapy is completed, bone marrow cells resume growth and development. The need for supportive care treatments (including red cell and platelet transfusions and drugs that stimulate the production of white and red blood cells), chemotherapy dose reductions/delays and hospitalizations related to chemotherapy-induced bone marrow suppression and infection are reduced with trilaciclib treatment, and the overall safety profile of chemotherapy regimens is improved without affecting antitumour effects.
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Acknowledgements
The manuscript was reviewed by: P.A. Bunn Jr., Department of Medicine, Division of Medical Oncology, University of Colorado Denver, Denver, CO, USA; R Tripathi, Department of Molecular and Biomedical Pharmacology, University of Kentucky School of Medicine, Lexington, KT, USA; F Rustemi, Health Insurance Fund, Tirana, Albania. During the peer review process, G1 Therapeutics, the marketing authorization holder of trilaciclib, was also offered an opportunity to provide a scientific accuracy review of their data. Changes resulting from comments received were made on the basis of scientific and editorial merit.
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ES Kim, a contracted employee of Adis International Ltd/Springer Nature, and SJ Keam, a salaried employee of Adis International Ltd/Springer Nature, declare no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.
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Kim, E.S., Keam, S.J. Trilaciclib for the reduction of chemotherapy-induced myelosuppression in the management of extensive-stage small cell lung cancer: a profile of its use. Drugs Ther Perspect 38, 64–71 (2022). https://doi.org/10.1007/s40267-021-00889-0
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DOI: https://doi.org/10.1007/s40267-021-00889-0