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
Side effects of Zepzelca (lurbinectedin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
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%)
Zepzelca (lurbinectedin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
The following Zepzelca (lurbinectedin) 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.
Common questions about Zepzelca (lurbinectedin)
Usually, you’ll get Zepzelca (lurbinectedin) as an IV infusion every 3 weeks, on day 1 of each 21-day treatment cycle. The infusion typically only takes 1 hour, but you’ll probably have other things to do during your infusion appointment day, like getting blood tests. It’s a good idea to dress comfortably and bring activities like books or music to help pass the time.
How long you take Zepzelca (lurbinectedin) depends on the balance between how well the medication is working to treat your cancer and how severe any side effects you have from the treatment are. Usually, your provider will take scans about every 6 to 8 weeks to check on your cancer. If there are signs that your cancer is getting worse on the scans or if you’re having worsening symptoms of your cancer, you and your provider might have to discuss changing your treatment plan. Similarly, if side effects like low blood cell counts or fatigue are too burdensome, your provider might stop your Zepzelca (lurbinectedin) treatment and change your treatment plan.
Fatigue is a common side effect of many cancer medications, including Zepzelca (lurbinectedin). Do your best to stay well-rested, eat well, and drink plenty of water while you’re taking Zepzelca (lurbinectedin). You can also try keeping track of your energy levels throughout treatment so you can schedule activities when you have more energy. Talk with your healthcare team if fatigue is disrupting your daily activities. They might have other recommendations to help with your fatigue or adjust your treatment plan to help with your symptoms.
Zepzelca (lurbinectedin) often lowers the amount of blood cells in your body. Before each infusion, your provider will check your blood cell counts to make sure it’s safe for you to receive treatment. Your provider might pause your treatment with Zepzelca (lurbinectedin) if your white blood cell (neutrophil) or platelet count is too low or if you have a fever along with a low white blood cell count (neutropenic fever). Your provider might also give you an injection to help boost your white blood cells and lower your risk for infection after each Zepzelca (lurbinectedin) infusion. Additionally, your provider might give you transfusions if your red blood cell or platelet counts are very low. Once your blood cell counts recover and your provider has determined it’s safe to restart Zepzelca (lurbinectedin), you’ll probably take the medication at a lower dose.
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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
Typical dosage 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)?
Zepzelca (lurbinectedin) images
