Next Steps in Managing Chemo-Induced Myelosuppression

Jared Weiss, MD: Thinking about future agents in the pipeline to reduce myelosuppression, plinabulin is a microtubule-binding agent. But it’s being studied more in non–small cell myelosuppression and for its immunomodulatory properties. The other emerging data that I would call out is ALRN-6924. This is a first-in-class MDM2/MDMX inhibitor. In plain English, it activates TP53. And it just showed some early favorable data at the EORTC-NCI-AACR symposium on molecular targets and cancer therapeutics.

At this moment in time, trilaciclib is approved only prior to carboplatin-etoposide, carboplatin-etoposide-atezolizumab, or topotecan in small cell lung cancer. I’m not recommending it for use in other cancers. In considering future directions, I see 2 potential impacts for trilaciclib in other cancers. No. 1, any cancer treated with chemotherapy has myelosuppression and the quality-of-life implications of myelosuppression and is worthy of being studied with trilaciclib. I would particularly call out cancers for which there are good data on a relationship between dose intensity and survival. And here, I would consider breast cancer and some of the lymphomas as areas where the preservation of the intensity of the therapy might improve not only quality of life but also survival. More specifically, I’d call out a phase 3 trial in progress. It’s in patients getting gemcitabine and carboplatin for locally advanced unresectable or metastatic triple-negative breast cancer. This is called the PRESERVE 2 trial.

Charu Aggarwal, MD, MPH: We’ve seen a lot of advances in the last few years. We have long-acting agents. We also have several biosimilars that are approved in an effort to reduce costs. We now also have trilaciclib, which is included in the NCCN [National Cancer Comprehensive Network] Guidelines. We’ve made tremendous progress. I’d like to see a larger study of trilaciclib in the future. I’d also like to ensure that we’re providing an overall improvement, not just in reduction in myelosuppression but based on the hypothesis that this may support the immune microenvironment. It would be amazing if we could show that overall survival outcomes are improved with the addition of these agents, and I look forward to incorporating them into my clinical practice.

Trilaciclib may have a role in other solid tumors based on the hypothesis of supporting immune microenvironment as chemoimmunotherapy approaches become available for other solid tumors—not just non–small cell lung cancer, but other diseases where dose-dense chemotherapies or chemotherapies with a high myelosuppressive potential are used routinely.

Transcript edited for clarity.