Aakash Desai, MD, MPH Hematology-Oncology Fellow at Mayo Clinic. In this video, he speaks about the IASLC 2022 Abstract - Real-World Experience of Lurbinectedin Beyond the Second Line in Small Cell Lung Cancer.
Patients with small cell lung cancer (SCLC) have few alternatives for treatment after platinum-based regimens and immunotherapy. The US Food and Drug Administration (FDA) has granted fast approval to lurbinectedin, an alkylating agent, for patients with metastatic SCLC who have progressed on or after traditional frontline therapy.
We describe our institutional experience with lurbinectedin in the third-line context or beyond for SCLC in this paper.
We identified 74 distinct patients who got lurbinectedin for SCLC at our institution between June 2020 and November 2021. We eliminated individuals with extrapulmonary small cell tumors or poorly differentiated neuroendocrine tumours who got lurbinectedin in the second line or did not receive it as intended. Fourteen patients met our criteria, and we collected information on the following variables for each: age at diagnosis, gender, number of prior lines of therapy, prior platinum, immunotherapy, and topotecan therapy, number of cycles, date of lurbinectedin initiation, dose, date of progression, date of last follow-up, and toxicity data.
The cohort's median age at diagnosis was 59 years, with 50% of the participants being female. The cohort's median follow-up time was 5.9 months. 86 percent of the patients in the group had de novo SCLC, while 14 percent had EGFRm NSCLC converted to SCLC. At the time of diagnosis, 85% of patients had advanced-stage SCLC. Lurbinectedin was administered to patients in the third (78.5%), fourth (14.2%), or fifth (7.1%) line settings. Three patients received no prior topotecan, and one patient received no prior platinum drug. The median number of lurbinectedin cycles was 4.5 (range: 1-10), with the majority (86%) receiving the normal dose of 3.2 mg/m2. Due to a history of myelosuppression from previous chemotherapy, 14% of patients got an empiric dose reduction. Neutropenia (21%) was the most common adverse event, followed by tiredness (14%), anemia (14%), and febrile neutropenia (14%). (7 percent ). Due to neutropenia, 14% of patients required a dosage reduction. Growth factor assistance was administered to 21% of patients as either secondary prophylaxis for grade 2 neutropenia (14%), or as primary prophylaxis (7 percent ). The cohort's median progression-free survival (PFS) was 3.8 months. There were no deaths while taking lurbinectedin at 3.2 mg/m2.
Lurbinectedin was generally well tolerated in the third or later line setting for relapsed SCLC, with a median PFS of 3.8 months. If not given earlier, these findings support the use of lurbinectedin in the third-line or later scenario.