Strategies for Preventing and Managing Treatment Related Neutropenia

Neutropenia management in small cell lung cancer (SCLC) varies significantly across institutions, with some incorporating primary prophylaxis with growth factors into standard order sets while others use risk-based approaches. Dr Cooper notes institutional variations in G-CSF prophylaxis practices, with some centers providing routine primary prophylaxis for platinum-etoposide therapy while others reserve growth factors for patients who develop neutropenia after initial cycles. The panel discusses trilaciclib as an emerging option that addresses not only neutropenia but also anemia and thrombocytopenia, potentially offering advantages over traditional G-CSF approaches.

Dr Sands highlights trilaciclib’s unique mechanism of protecting all 3 cell lines, leading to improved patient-reported outcomes including reduced fatigue. The drug’s ability to prevent chemotherapy-induced anemia may contribute to decreased fatigue beyond its neutropenia protection, as anemia-related fatigue can compound chemotherapy-induced symptoms. The panel particularly notes trilaciclib’s effectiveness in managing prolonged thrombocytopenia in patients on anticoagulation therapy, representing a specific clinical scenario where multilineage protection proves beneficial.

Risk stratification for growth factor prophylaxis focuses on patient age, comorbidities, and prior treatment history, particularly for patients receiving rechallenge platinum-etoposide therapy after limited-stage disease recurrence. Dr Leal emphasizes following established guidelines while considering practical factors such as patient age over 70, significant comorbidities, and previous treatment-related hematologic complications. The approach balances treatment intensity maintenance with safety considerations, recognizing that dose modifications may compromise efficacy while growth factor support can help maintain optimal dosing schedules for improved outcomes.