Zepzelca
Zepzelca (lurbinectedin) is a chemotherapy medication that’s used to treat metastatic small cell lung cancer (SCLC) after platinum-based therapies no longer work. It’s given as an infusion through the vein once every 3 weeks, so it can be a convenient option. This medication often causes side effects like nausea, fatigue, and low blood cell counts.
What is Zepzelca (lurbinectedin)?
What is Zepzelca (lurbinectedin) used for?
Metastatic small-cell lung cancer (SCLC) after platinum-based chemotherapy has stopped working
How Zepzelca (lurbinectedin) works
Zepzelca (lurbinectedin) is a type of chemotherapy called an alkylating agent. It works by damaging DNA, the genetic material in each cell that’s needed for normal growth and function. By damaging the DNA in cancer cells, the medication causes the cells to die. This prevents the cancer from growing or spreading as quickly.
Drug Facts
What are the side effects of Zepzelca (lurbinectedin)?
Common Side Effects
- Lower blood cell counts (up to 79%)
- Fatigue (77%)
- Signs of stress to the kidney on blood tests (up to 69%)
- Signs of stress to the liver on blood tests (up to 66%)
- High blood sugar levels (52%)
- Nausea (37%)
- Muscle, bone, or joint pain (33%)
- Not feeling hungry (33%)
- Constipation (31%)
- Feeling short of breath (31%)
Serious Side Effects
- Low blood cell counts: unusual bleeding or bruising, fever, feeling very tired
- Liver injury: pain on the right side of the stomach, yellowing of the eyes or skin, dark or brown urine
- Severe muscle damage: dark brown urine, severe muscle pain, tiredness
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Infection—fever, chills, cough, sore throat, wounds that don't heal, pain or trouble when passing urine, general feeling of discomfort or being unwell
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low red blood cell level—unusual weakness or fatigue, dizziness, headache, trouble breathing
- Muscle injury—unusual weakness or fatigue, muscle pain, dark yellow or brown urine, decrease in amount of urine
- Painful swelling, warmth, or redness of the skin, blisters or sores at the infusion site
- Unusual bruising or bleeding
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Constipation
- Cough
- Diarrhea
- Fatigue
- Loss of appetite
- Nausea
Pros and cons of Zepzelca (lurbinectedin)
Pros
Given every 3 weeks
Short infusion time of 1 hour
Recommended option for small cell lung cancer after platinum-based chemotherapy stops working
Cons
Often causes low blood cell counts
Frequently causes nausea, low appetite, and fatigue
Can rarely cause infusion-related tissue injury (pain, swelling, or burning around the IV site)
Pharmacist tips for Zepzelca (lurbinectedin)
Nausea and vomiting are common side effects of Zepzelca (lurbinectedin). To prevent these side effects, you’ll get “premedications” before each infusion. You’ll also have medications to prevent nausea and vomiting that you can take as needed during your treatment cycle. Other things you can do to help are to eat small, frequent meals and take small sips of liquid to stay well-hydrated.
Zepzelca (lurbinectedin) can put you at higher risk of bleeding and infections. This is because the medication can lower the amounts of red blood cells (responsible for carrying oxygen through your body), white blood cells (responsible for fighting infections), and platelets (responsible for blood clotting) in your body. Tell your provider right away if you suddenly have unusual bleeding or bruising, muscle weakness, or changes in your speech and vision or if you develop a fever.
Make sure to provide your healthcare team with a complete list of all medications, supplements, and herbals you’re taking so that they can make sure what you’re taking is safe to use with Zepzelca (lurbinectedin). Zepzelca (lurbinectedin) interacts with many medications, supplements, and other food products. For instance, avoid grapefruit juice and Seville oranges during treatment because they can raise Zepzelca (lurbinectedin) levels in the blood, which might raise your risk for side effects.
If you’re able to have children, make sure to use birth control while you’re taking Zepzelca (lurbinectedin) and for at least 6 months after your last dose. If you’re male and have a partner who can become pregnant, continue using condoms if you have sex anytime during treatment and for at least 4 months after the last dose. Zepzelca (lurbinectedin) can potentially harm an unborn baby when taken during pregnancy.
Avoid breastfeeding while you’re getting treated with Zepzelca (lurbinectedin) and for at least 2 weeks after your last dose. We don’t know whether it’s safe to breastfeed during treatment because Zepzelca (lurbinectedin) hasn’t been studied in people who are breastfeeding.
Frequently asked questions about Zepzelca (lurbinectedin)
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What are the risks and warnings for Zepzelca (lurbinectedin)?
Zepzelca (lurbinectedin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts (myelosuppression)
Zepzelca (lurbinectedin) can affect your bone marrow and cause your body to make fewer blood cells. Low amounts of blood cells can put you at greater risk of bleeding and make you more likely to get infections, which could be life-threatening. Usually, your blood cell counts will be at their lowest (a time point called nadir) around day 15 of each cycle and take about a week to return to normal. You’ll have your blood drawn before each Zepzelca (lurbinectedin) infusion to make sure the medication is safe to take.
Your provider might give some additional medications to help prevent complications of having low blood cell counts from Zepzelca (lurbinectedin) treatment. You might get injections to boost up your white blood cells and prevent infections. You might also receive transfusions if your red blood cell or platelet counts are low. Your provider might lower your Zepzelca (lurbinectedin) dose as well. Talk to your provider right away if you suddenly have unusual bleeding or bruising, muscle weakness, changes in your speech and vision, or develop a fever.
Liver injury
Zepzelca (lurbinectedin) might cause damage to your liver. Sometimes, you might not feel any symptoms when there are problems with the liver, so you’ll need blood tests before each infusion to check your liver health. In studies, some people had higher levels of liver enzymes on their blood tests (a sign of potential liver injury) within the first 8 days of starting treatment; levels went back to normal about a week later.
Tell your healthcare team if you notice signs of liver damage, such as pain on the right side of the stomach, yellowing of the eyes or skin, or dark or brown urine. If your provider suspects that you have liver damage, you might need to take a break from treatment. Once your liver test results return to normal, you might be able to restart the medication.
Infusion-related tissue injury
Sometimes, Zepzelca (lurbinectedin) can leak out of the veins while you’re getting your infusion. This can cause irritation and damage to the surrounding tissue, muscle, or skin. Your care team should properly administer the medication into your vein to avoid this problem, but there’s still a small risk of this happening. Let your provider or nurse know right away if you feel pain, swelling, or burning around the IV site.
Severe muscle damage (rhabdomyolysis)
Zepzelca (lurbinectedin) can cause a rare, but serious and life-threatening muscle problem called rhabdomyolysis. While you’re getting treated with Zepzelca (lurbinectedin), your provider will check your blood to make sure there aren’t any signs suggesting muscle damage. Let your provider know if you notice any symptoms of rhabdomyolysis, such as severe muscle pain, dark-colored urine, or muscle weakness.
Harm to the unborn baby
Let your provider know if you’re pregnant or planning to become pregnant. Zepzelca (lurbinectedin) is likely to harm unborn babies when taken during pregnancy. If you’re able to have children, your provider will have you take a pregnancy test before starting treatment. They’ll also ask you to use reliable birth control while you’re taking this medication and for at least 6 months after your last dose. If you’re male and have a partner who’s able to become pregnant, continue using birth control (e.g., condoms) if you have sex anytime during treatment until at least 4 months after the last dose.
Zepzelca (lurbinectedin) dosage forms
Typical dosing for Zepzelca (lurbinectedin)
Your dose will depend on your body surface area (BSA), which is your body size calculated based on your weight and height.
Typically, the dose is 3.2 mg/m2 of BSA given as an infusion through the vein (IV) once every 3 weeks.
What are alternatives to Zepzelca (lurbinectedin)?
Metastatic small-cell lung cancer (SCLC) after platinum-based chemotherapy has stopped working
Metastatic ovarian cancer that continued to spread after other chemotherapy
Platinum-sensitive small cell lung cancer (SCLC) that continued to spread after other chemotherapy
Advanced cervical cancer, along with cisplatin (Platinol)
Zepzelca (lurbinectedin) images
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References
Best studies we foundAmerican Cancer Society. (2019). How chemotherapy drugs work.
American Cancer Society. (2020). Understanding nausea and vomiting.
American Cancer Society. (2022). Low white blood cell counts (neutropenia).
Fernández-Teruel, C., et al. (2021). Population pharmacokinetic-pharmacodynamic modeling and covariate analyses of neutropenia and thrombocytopenia in patients with solid tumors treated with lurbinectedin. Journal of Clinical Pharmacology.
Jazz Pharmaceuticals, Inc. (2023). Zepzelca- lurbinectedin injection, powder, lyophilized, for solution [package insert]. DailyMed.
Jazz Pharmaceuticals. (n.d.). How will I receive Zepzelca® (lurbinectedin)?
National Cancer Institute. (n.d.). Extravasation.
National Cancer Institute. (2021). Fatigue and cancer treatment.
National Cancer Institute. (2023). Small cell lung cancer treatment (PDQ®)–Patient version.
National Comprehensive Cancer Network. (2022). Small cell lung cancer.
Patel, K., et al. (2017). Febrile neutropenia. Journal of the American Medical Association Oncology.
Stewart, D. J., et al. (2019). Optimal frequency of scans for patients on cancer therapies: A population kinetics assessment. Cancer Medicine.
U.S. Food and Drug Administration. (2021). Grapefruit juice and some drugs don't mix.
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