Trilaciclib in the prevention of chemotherapy-induced myelosuppression in extensive stage small cell lung cancer:a systematic review and Meta-analysis

WANG Zhen-huan; ZHAO Ying; QIU Ting-ting; LIU Ran-jia; WU Yi; GUO Ming-xing; LI Ying; CUI Xiang-li

doi:10.20251/j.cnki.1003-3734.2025.21.014

Abstract：Objective:To systematically review the effectiveness,safety,anti-tumor efficacy,and cost-effectiveness of trilaciclib in preventing chemotherapy-induced myelosuppression(CIM)in extensive stage small cell lung cancer(ES-SCLC),providing evidence-based support for rational drug use in clinical practice.Methods:Databases of PubMed,Embase,CENTRAL,CNKI,WangFang Data,and SinoMed were systematically searched.Randomized controlled trials(RCT)and economics research of preventing CIM with the use of trilaciclib or placebo prior to chemotherapy up to August 2024 were included.Reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the risk bias of included studies.Then descriptive analysis or Meta-analysis was conducted using the RevMan 5.4 software.Results:A total of four RCTs involving 327 patients were included.Risk bias assessment results showed moderate bias.The Meta-analysis results showed that in terms of effectiveness,the incidence of severe neutropenia[RR=0.18,95%CI(0.05,0.63),P=0.008],neutropenia with fever[RR=0.27,95%CI(0.10,0.71),P=0.008],leukopenia[RR=0.34,95%CI(0.17,0.67),P=0.002],anemia[RR=0.68,95%CI(0.57,0.82),P<0.000 1]in the trilaciclib group were superior to the placebo group.The duration of severe neutropenia[MD=-3.23,95%CI(-4.38,-2.07),P<0.000 01]was shorter than the placebo group.The utilization rate of erythropoiesis-stimulating agent(ESA)[RR=0.49,95%CI(0.25,0.97),P=0.04]and the transfusion rate of red blood cells after 5 weeks of treatment[RR=0.59,95%CI(0.36,0.95),P=0.03]were significantly lower in the trilaciclib group.In terms of safety,there was no statistically significant difference in the incidence of all-cause mortality and different types of AEs between the two groups(P>0.05).In terms of anti-tumor efficacy,there was no significant difference in objective response rate,progression free survival,and overall survival between the two groups(P>0.05).In terms of economics,a total of four studies were included,and foreign data showed that trilaciclib was cost-effective.Conclusion:The use of trilaciclib before chemotherapy in ES-SCLC patients can effectively reduce the occurrence of CIM,reduce supportive treatments such as ESA and red blood cell transfusion,with good safety,no significant impact on survival,and can reduce the economic burden on patients.High quality research is still needed in the future to further evaluate the long-term survival outcomes.