Trilaciclib for Myeloprotection During Induction and Maintenance in ES-SCLC

Dr. Shields discusses trilaciclib, an FDA-approved supportive care medication from 2021 that prevents myelosuppression across red cells, white cells, and platelets, plus neutropenia. She uses it for every patient with ES-SCLC during chemotherapy-immunotherapy induction, noting patients experience meaningful clinical benefit from maintaining higher hemoglobin levels, making them more robust for subsequent treatment intensification.

Despite trilaciclib's benefits during induction, she switches to G-CSF when transitioning to maintenance per label requirements, though she expresses interest in studies examining trilaciclib's role during lurbinectedin-based maintenance, referencing an investigator-initiated safety study by Jared Weiss. She acknowledges patient disappointment when discontinuing trilaciclib for G-CSF, given trilaciclib's more favorable side effect profile compared to G-CSF's flu-like symptoms and arthralgias.

Dr. Sands notes he doesn't commonly use trilaciclib, finding the mechanism interesting given SCLC's near-universal RB1 and p53 loss, meaning trilaciclib protects normal cells from chemotherapy toxicity without affecting cancer cell division (unlike CDK4/6 inhibitors in breast cancer that arrest cancer cell cycling).

Dr. Shields highlights that trilaciclib's patient-reported outcomes data revealed reduced fatigue compared to placebo, suggesting chemotherapy-associated anemia significantly contributes to fatigue burden beyond expected baseline levels. She anticipates expanding trilaciclib use as antibody-drug conjugates causing cytopenias enter SCLC treatment, with ongoing studies examining trilaciclib in limited-stage disease with concurrent chemoradiotherapy, including an Emory-conducted safety study combining trilaciclib with radiation.