Myeloprotection effect of trilaciclib in lung cancer patients undergoing chemotherapy: a real-world retrospective study.

BACKGROUND

Chemotherapy-induced myelosuppression (CIM) is a frequent complication in lung cancer, leading to treatment delays, dose reductions, and increased healthcare utilization. Trilaciclib, a first-in-class CDK4/6 inhibitor with myeloprotective properties, has been approved for extensive-stage small-cell lung cancer (ES-SCLC), but real-world evidence in broader lung cancer populations is limited. This retrospective real-world study aimed to evaluate the myeloprotection effects of trilaciclib in lung cancer patients undergoing chemotherapy.

METHODS

We conducted a retrospective analysis of lung cancer patients who received chemotherapy at the First Affiliated Hospital of Air Force Medical University between January 2023 and June 2024. Patients were categorized into trilaciclib group and non-trilaciclib group. Baseline characteristics, myelosuppression grades, drug dosages for myelosuppression treatment, chemotherapy delays, hospitalizations, and alopecia were collected and analyzed. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline imbalances.

RESULTS

A total of 108 patients were included (54 per group). Overall myelosuppression incidence did not differ significantly (74.1% vs. 87%, P=0.09), but grade ≥3 myelosuppression was markedly reduced in the trilaciclib group [40% vs. 66%, IPTW-adjusted odds ratio (OR) =2.90, P=0.02]. The trilaciclib group required fewer therapeutic granulocyte colony-stimulating factor (G-CSF) doses [median 2 vs. 6, IPTW-adjusted rate ratio (RR) =1.74, P=0.02] and had a lower incidence of grade ≥3 alopecia (77.8% vs. 93.2%, P=0.04), but not significant after IPTW adjustment. Myelosuppression-related hospitalization was significantly reduced (13% vs. 50%, IPTW-adjusted OR =7.77, P<0.001), while chemotherapy delays and other supportive medication use were similar.

CONCLUSIONS

In a real-world cohort of patients with locally advanced or metastatic lung cancer receiving chemotherapy, trilaciclib was associated with a lower incidence of severe myelosuppression, reduced G-CSF utilization, and fewer hospitalizations. These findings should be considered exploratory, and may support the potential role of trilaciclib as a myeloprotective strategy to optimize treatment continuity and reduce healthcare burden.