Trilaciclib for prophylaxis of chemotherapy-induced myelosuppression in solid tumor patients: a systematic review and meta-analysis

Objective: To systematically evaluate the clinical benefit and safety of trilaciclib in solid-tumor patients receiving chemotherapy and to inform clinical practice. Methods: Following PRISMA guidelines and registered at PROSPERO (CRD420251053232), we searched PubMed, Embase and two other databases from inception to June 2025. Six randomized controlled trials enrolling 726 patients were included. Meta-analyses were performed with Review Manager 5.4. Results: Trilaciclib significantly reduced the incidence of severe neutropenia (SN) and febrile neutropenia (FN), shortened SN duration, and decreased the need for erythropoiesis-stimulating agents (ESAs), granulocyte colony-stimulating factor (G-CSF) and red-blood-cell (RBC) transfusions while lowering anemia rates. These benefits were not accompanied by increased risks of nausea, vomiting or fatigue. Progression-free survival (PFS) was significantly prolonged, whereas overall survival (OS) remained unchanged; patients aged ≥65 years and those enrolled in U.S. trials derived the greatest benefit. Limitations include the small number of RCTs, heterogeneous chemotherapy regimens, potential publication bias and short follow-up in some studies. Conclusion: Trilaciclib effectively prevents chemotherapy-induced myelosuppression in solid-tumor patients and can guide clinical use, but further well-designed studies are warranted to consolidate its efficacy and safety profile. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251053232URL.