Retsevmo (selpercatinib) vs Cosela (trilaciclib)

Retsevmo (selpercatinib) is a targeted therapy specifically designed to treat certain types of thyroid cancers and non-small cell lung cancer (NSCLC) with RET gene alterations, functioning as a RET kinase inhibitor. Cosela (trilaciclib), on the other hand, is a myeloprotection agent used to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for extensive-stage small cell lung cancer (ES-SCLC). The choice between Retsevmo and Cosela would depend on the specific type of cancer a patient has, the genetic makeup of the tumor, and the treatment regimen being used, as they serve different purposes in cancer management.

Difference between Retsevmo and Cosela

Metric	Retsevmo (selpercatinib)	Cosela (trilaciclib)
Generic name	Selpercatinib	Trilaciclib
Indications	Advanced or metastatic RET fusion-positive non-small cell lung cancer, advanced or metastatic RET-mutant medullary thyroid cancer, and advanced or metastatic RET fusion-positive thyroid cancer	Used to decrease the incidence of chemotherapy-induced myelosuppression in adult patients when administered prior to a platinum/etoposide-containing regimen or topotecan-containing regimen for extensive-stage small cell lung cancer (ES-SCLC)
Mechanism of action	RET kinase inhibitor	CDK4/6 inhibitor
Brand names	Retsevmo	Cosela
Administrative route	Oral	Intravenous
Side effects	Increased AST/ALT, increased blood glucose, decreased leukocytes, decreased albumin, decreased calcium, dry mouth, diarrhea, increased creatinine, hypertension, fatigue, edema, rash, and constipation	Fatigue, hypocalcemia, increased aspartate aminotransferase, increased alanine aminotransferase, hypokalemia, pneumonia, headache, and pneumonia
Contraindications	Hypersensitivity to selpercatinib	Hypersensitivity to trilaciclib
Drug class	Tyrosine kinase inhibitor	Cyclin-dependent kinase inhibitor
Manufacturer	Lilly	G1 Therapeutics

Efficacy

Efficacy of Retsevmo (selpercatinib) in Lung Cancer

Retsevmo (selpercatinib) has shown efficacy in the treatment of certain types of lung cancer, particularly non-small cell lung cancer (NSCLC) that is RET fusion-positive. RET fusion-positive NSCLC is a subtype of lung cancer characterized by rearrangements in the RET gene. Selpercatinib is a selective RET kinase inhibitor that targets RET-driven cancers. In clinical trials, selpercatinib demonstrated significant antitumor activity in patients with RET fusion-positive NSCLC, including those who were previously treated with platinum chemotherapy and those who were treatment-naïve.

The efficacy of selpercatinib was evaluated in a multi-center, open-label, multi-cohort clinical trial. The results showed a high objective response rate (ORR), which is the proportion of patients with a significant reduction in tumor size, and a durable response, meaning that the reduction in tumor size was maintained over time. Additionally, selpercatinib was found to have intracranial activity, indicating effectiveness in treating brain metastases associated with RET fusion-positive NSCLC.

Efficacy of Cosela (trilaciclib) in Lung Cancer

Cosela (trilaciclib) is a first-in-class myeloprotection agent designed to protect bone marrow from damage caused by chemotherapy. While it is not a direct treatment for lung cancer itself, it is approved for use in patients with extensive-stage small cell lung cancer (ES-SCLC) to decrease the incidence of chemotherapy-induced myelosuppression. Myelosuppression is a common and serious side effect of chemotherapy that can lead to complications such as anemia, neutropenia, and thrombocytopenia. By protecting bone marrow cells from the harmful effects of chemotherapy, trilaciclib can help patients maintain their chemotherapy regimen as scheduled, which is crucial for the efficacy of cancer treatment.

In clinical trials, trilaciclib demonstrated a significant reduction in the occurrence of severe neutropenia, a condition where a patient has an abnormally low count of a type of white blood cell called neutrophils. The drug also reduced the need for supportive care interventions such as granulocyte colony-stimulating factor (G-CSF) administration or blood transfusions. Moreover, trilaciclib showed potential improvements in overall survival and progression-free survival, although these outcomes require further investigation to establish definitive benefits in the context of lung cancer treatment.

Regulatory Agency Approvals

Retsevmo

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

Cosela

Food and Drug Administration (FDA), USA

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