Lurbinectedin (Zepzelca) is an innovative medication for the treatment of small cell lung cancer (SCLC). As a type of alkylating agent, it exerts antitumor activity through multiple mechanisms.

Dosage and Administration of Lurbinectedin (Zepzelca)

Recommended Standard Dosage

The recommended standard dosage of lurbinectedin is 3.2 mg/m², administered as an intravenous infusion once every 21 days, with each infusion lasting 60 minutes.

Treatment should be continued until disease progression or the occurrence of unacceptable toxicity.

Pre-Treatment Requirements

Absolute neutrophil count (ANC) ≥ 1,500 cells/mm³.

Platelet count ≥ 100,000/mm³.

Treatment may only be initiated if the above criteria are met.

Combination Therapy Regimen

When lurbinectedin is used in combination with atezolizumab or atezolizumab-hyaluronidase-tqjs, the selected atezolizumab-containing product must be administered first on the same day, followed by lurbinectedin.

Dose Adjustments for Lurbinectedin (Zepzelca)

Principles of Dose Adjustment

Dose adjustments of lurbinectedin follow a stepwise reduction schedule based on the severity of adverse reactions.

First dose reduction: 2.6 mg/m² once every 21 days.

Second dose reduction (if needed): 2.0 mg/m² once every 21 days.

If the patient cannot tolerate the 2.0 mg/m² dose, permanent discontinuation of lurbinectedin is recommended.

Management of Myelosuppression

Discontinue treatment in the event of grade 4 neutropenia or febrile neutropenia of any grade.

Resume treatment at the next lower dose once the absolute neutrophil count recovers to ≥ 1,500 cells/mm³.

Discontinue treatment in patients with severe thrombocytopenia (grade 3 with bleeding or grade 4).

Resume treatment at the next lower dose once the platelet count recovers to ≥ 100,000/mm³.

Management of Hepatotoxicity

Grade 2 hepatotoxicity: Discontinue treatment until recovery to grade 1 or less, then resume at the original dose.

Grade ≥ 3 hepatotoxicity: Discontinue treatment until recovery to grade 1 or less, then resume at the next lower dose or discontinue permanently.

Use in Special Populations

Patients with Hepatic Impairment

Severe hepatic impairment (total bilirubin > 3 × upper limit of normal [ULN]): Avoid use if possible. If unavoidable, the recommended dose is reduced to 1.6 mg/m² once every 21 days.

Moderate hepatic impairment (total bilirubin > 1.5 to ≤ 3 × ULN and any AST level): Recommended dose is 1.6 mg/m² once every 21 days.

Pregnant and Lactating Women

Pregnant women: Based on its mechanism of action and animal study data, lurbinectedin may cause fetal harm.

Females of reproductive potential: Effective contraception is recommended during treatment and for 6 months after the last dose.

Male patients: Effective contraception is recommended during treatment and for 4 months after the last dose.