There are many treatment options for lung cancer, but the right one for you will depend on many factors, including the type of lung cancer you have. There are two main types of lung cancer: non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Zepzelca (lurbinectedin) is one treatment option for certain people with SCLC.
Is Zepzelca Right for Me?
To help choose the right treatment for you, your health care provider will consider what type of lung cancer you have, the treatments you have received, and whether the cancer has spread. Zepzelca is a type of chemotherapy used for SCLC that has spread. Your health care provider may recommend Zepzelca if you have extensive-stage SCLC that has spread widely throughout the lung, to the other lung, or to other parts of the body. Metastatic SCLC, cancer that has spread to other parts of the body, is one type of extensive-stage SCLC.
How Does Zepzelca Work for SCLC?
Zepzelca is a type of chemotherapy known as an alkylating agent. It binds with the DNA in your cells and makes it difficult for the cancer cells to repair themselves. Over time, cancer cells fail to grow and eventually die.
How Do I Use Zepzelca?
Zepzelca is an infusion given by your health care provider in an office, clinic, or infusion center. Zepzelca is usually given every three weeks, with each infusion lasting about one hour. Your health care provider will decide how long you will be treated with Zepzelca.
Your health care provider may recommend that you receive Zepzelca in combination with a type of immunotherapy called atezolizumab. If you are receiving Zepzelca and atezolizumab on the same day, you will receive atezolizumab first.
How Was Zepzelca Studied for SCLC?
Zepzelca was studied in two ways for people with SCLC:
- For people with extensive-stage SCLC whose cancer did not progress (get worse) after induction treatment (the initial phase of chemotherapy treatment aimed at killing as many cancer cells as possible) with chemotherapy plus atezolizumab
- For people with metastatic SCLC whose cancer worsened during or after their treatment with chemotherapy
The main study for people whose cancer did not worsen after initial treatment with chemotherapy plus atezolizumab is known as the IMforte study. In this study, everyone had untreated, extensive-stage SCLC that had not spread to the brain or spinal cord. They were first treated with a chemotherapy treatment that included atezolizumab, carboplatin, and etoposide. After this treatment, people were treated with either the combination of Zepzelca and atezolizumab or with atezolizumab alone. People continued treatment until they did not tolerate treatment or until their disease worsened.
People were followed to see how long it took for their lung cancer to progress, meaning that the cancer grew or spread. This measurement is called progression-free survival (PFS). The study also looked at overall survival (OS), which measures how long people are alive after they start the study.
The IMForte study involved 483 people, including 242 treated with Zepzelca plus atezolizumab and 241 treated with atezolizumab alone. The median age of people in the study was 66 years, meaning that half were younger and half were older than 66. Most people in the study (98%) smoked or had smoked in the past. A total of 82% of people were White, 13% were Asian, 0.8% were Black or African American, and 7% were of Hispanic or Latino ethnicity. Almost two-thirds (63%) of people in the study were men.
In the main study for people with metastatic SCLC (cancer that spread to areas outside of the lungs) whose cancer progressed during or after their treatment with chemotherapy, 105 people were treated with Zepzelca. People continued treatment with Zepzelca until they did not tolerate treatment or until their disease progressed.
The people were followed to see if their tumors shrank or disappeared. This measurement is called the overall response rate. A response can either be a “partial response,” when the tumor shrinks, or a “complete response,” where the tumor disappears.
The median age of people in the study was 60 years. A total of 75% of people were White, 1% were Asian, 1% were Black, and about 23% did not report their race. Most people in the study (92%) smoked or had smoked in the past, and 60% were men.
What Are the Main Benefits of Zepzelca Based on Studies?
In the IMforte study, the median PFS was 5.4 months for people who took Zepzelca and atezolizumab compared to 2.1 months for those who received only atezolizumab. This means that half of the people who took Zepzelca and atezolizumab did not have their cancer progress for at least 5.4 months compared to 2.1 months for people who received atezolizumab. People treated with atezolizumab alone were more likely to have their cancer worsen than those who were treated with Zepzelca and atezolizumab. The median OS for people who took Zepzelca and atezolizumab was 13.2 months compared to 10.6 months for the people who only received atezolizumab. These results show that Zepzelca may help slow down the progression of your cancer and help you live longer.
In the main study for people with metastatic SCLC whose cancer worsened during or after their treatment with chemotherapy, 35% of people had a response. All 35% of responses were partial responses, with no one having a complete response. The median duration of response was 5.3 months with a median PFS of 3.5 months and a median OS of 9.3 months. After one year in the study, 34.2% of patients remained alive.
Your results may be different from what was seen in clinical studies.
What Can I Do to Prevent or Manage Side Effects of Zepzelca?
Side effects are common with cancer treatments, but your health care provider can help you prevent or manage side effects. You should talk to your health care provider if you think you have a side effect related to Zepzelca.
A few common side effects of Zepzelca and ways to manage them are mentioned below:
Tiredness. There are many reasons you might feel more tired while receiving chemotherapy with Zepzelca. You should try to get seven to eight hours of sleep each night and take only short naps during the day. You should eat a balanced diet and stay hydrated to help with tiredness. Avoid caffeine or alcohol in the evening, as these may affect sleep patterns. Other tips for reducing tiredness can be found here.
Nausea. You may have nausea or vomiting while taking Zepzelca. Your health care provider will give you medicine to help prevent nausea and vomiting before your first dose of Zepzelca. Your health care provider may decide to give you these medicines before every Zepzelca infusion. Eating small meals or snacks consisting of plain foods may help ease nausea and vomiting. Your health care provider may also suggest medicines to help with these side effects.
Pain. You may have pain in your muscles or joints while taking Zepzelca. You should describe your pain to your health care provider, who can recommend treatment for your specific pain. Severe muscle pain or weakness may be a sign of a serious side effect called rhabdomyolysis. Although rhabdomyolysis is a rare side effect, and your health care provider will do blood tests to check for this effect, tell your health care provider right away if you have severe muscle pain.
Are There Any Serious Side Effects of Zepzelca?
Zepzelca has been linked to some serious side effects. Your health care provider will check for these side effects, but you should contact your health care provider if you recognize any of the following:
- Low blood cell count. Zepzelca may cause low levels of white blood cells (neutropenia), which can increase your risk of infection. Contact your health care provider right away if you have signs or symptoms of an infection, such as fever or chills. Zepzelca may also cause low levels of platelets (thrombocytopenia). Contact your health care provider right away if you have unexpected bleeding or bruising. Your health care provider will do blood tests to monitor your blood cell counts before and during treatment with Zepzelca.
- Liver problems. Liver damage, also called hepatotoxicity, can happen when taking Zepzelca. Your health care provider will do blood tests to monitor how well your liver is working before and during treatment. Contact your health care provider if you notice any signs of liver problems.
- Stomach or belly pain
- Feeling very tired
- Weakness or unusual tiredness
- Loss of appetite
- Dark-colored urine (pee)
- Yellowing of your skin or the whites of your eyes (also called jaundice)
- Tissue Damage. Zepzelca is given as an infusion into a vein. If the medicine does not go into your vein, it could damage nearby tissue. Tell your health care provider right away if you have pain, swelling, warmth, or skin color changes where the medicine is being or was given.
Your health care provider may lower your dose of Zepzelca or stop the medicine for some time to help manage side effects. Do not stop Zepzelca without contacting your health care provider.
Is There Any Cost Assistance Available?
The manufacturer of Zepzelca has a program to assist you with access to your Zepzelca. You can find more information about this program here.
