A 61-Year-Old Man With Small Cell Lung Cancer - Episode 5

The Impact of Lurbinectedin in Small Cell Lung Cancer

Dr Ticiana Leal, MD, describes the choice to prescribe lurbinectedin in the second-line setting for the patient as well as her personal experience with the drug.

Ticiana Leal, MD: For this patient, the choice to use lurbinectedin in the second-line setting is appropriate. Lurbinectedin is an agent that has been studied in the phase 2 setting, and has been approved in an accelerated fashion given the benefits seen in the phase 2 setting with the response rate as well as duration of response. One important thing to think about if you’re moving on to second line in a patient with extensive-stage small cell lung cancer is that the number of patients who are able to receive third-line treatment is substantially lower. About half the patients are able to receive second-line treatments, and then only about 15% of the patients or less get to third-line treatment. Sometimes, when you’re faced with having that discussion with your patient, you have to really consider what the next-best line of therapy is for this patient that will impact the course of their disease. Importantly, think about toxicities and quality of life. Lurbinectedin for this patient is definitely an appropriate choice and is something I would discuss with my patient and their family. I would likely make a similar decision in this case.

My personal experience with lurbinectedin with the patients we have treated at the University of Wisconsin so far has been favorable. Specifically, the toxicities have been manageable. We talked about how myelosuppression has been the main adverse effect seen in the study, and we do see that in the clinical setting. But the treatment discontinuation and dose delays for patients have been manageable and have been something we have been able to clinically work with the patients on. It will be a learning curve as we gain more experience with using lurbinectedin.

In my own clinical practice, I’m still trying to learn more about the impact of lurbinectedin in patients who have a history of CNS [central nervous system] metastasis. In the phase 2 trial we talked about, patients with CNS metastasis were excluded so we don’t have any clinical trial data in terms of the activity of lurbinectedin in CNS metastasis and how it impacts patients with active CNS metastasis or previously treated CNS metastasis. That is also unfortunately a reason that patients have functional decline or progression while they’re being treated in the second-line setting.

Transcript edited for clarity.


Case: A 61-Year-Old Man With Small-Cell Lung Cancer

Initial Presentation

  • A 61-year-old man presented with a cough, fatigue, progressive shortness of breath
  • PMH: unremarkable
  • SH: 25-pack year smoking history; social alcohol use
  • PE: Right lower lobe wheezing on auscultation, axillary lymph node enlargement

Clinical Workup

  • Labs: WNL
  • Axillary lymph node biopsy revealed small cell carcinoma
  • Chest/abdomen/pelvic CT showed a 7.1 cm mediastinal conglomerate mass, with invasion into the right main and lobar pulmonary arteries; 2 small left pulmonary nodules; hypermetabolic axillary lymph node
  • PET scan showed large focal hypermetabolic activity in the mediastinum and small hypermetabolic activity in the surrounding area
  • Contrast‐enhanced MRI of the head showed no brain metastases
  • Stage IV small-cell lung cancer; ECOG PS 0

Treatment

  • Initiated carboplatin + etoposide + atezolizumab for 4 cycles; followed with atezolizumab as maintenance therapy

Follow-up

  • 7 months after starting treatment he complained of shortness of breath, right upper quadrant pain and back pain
  • CT showed hematogenous metastases in the liver and right adrenal gland
  • Initiated lurbinectedin 3.2 mg/m2 IV q21 Days