Use of five-day chronomodulated prescription of palbociclib as myelopreservation drug along with Topotecan in recurrent extensive stage small cell lung carcinoma - A perspective article

Myelopreservation is always a good option when prescribing myelotoxic chemotherapy like Topotecan. Bone marrow toxicity is one of the main hindrances in prescribing such chemotherapy. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6 inhibitors) are known to inhibit the Cell cycle in the G1-S phase. Inhibition of hematopoietic stem cells was the reason for CDK4/6 inhibitor – trilaciclib to be prescribed with Topotecan as a myelopreserving agent. Trilaciclib is an intravenous CDK4/6 inhibitor with a short half-life and can be co-prescribed with chemotherapy. Trilaciclib is currently not available in India. We propose the use of palbociclib, an oral CDK4/6 inhibitor, for the same indication. We suggest the use of a short course of palbociclib for five days, along with chemotherapy, as a myelopreserving agent. We also propose to chronomodulate the dose to maximize the effect.