Managing Lurbinectedin Adverse Events in ES-SCLC Maintenance Therapy
October 15, 2025
Key Points
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Lurbinectedin in combination with atezolizumab was approved as a maintenance regimen for first-line extensive-stage small cell lung cancer (ES-SCLC) based on the phase 3 IMforte trial.
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Dose interruptions and potential reductions are effective for managing adverse events that develop during maintenance treatment.
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Growth factor support should be utilized to prevent cytopenias in patients receiving lurbinectedin, which has been done in the second-line and later settings.
Adverse Events With Lurbinectedin in IMforte
Lurbinectedin plus atezolizumab was approved for first-line maintenance therapy after induction in patients with untreated ES-SCLC. During a roundtable discussion, thoracic oncologists Isabel Preeshagul, DO, MBS, of Memorial Sloan Kettering Cancer Center, and Stephen Liu, MD, of Georgetown Lombardi Cancer Center, discussed side effects reported in the pivotal phase 3 IMforte trial and what clinicians can expect when utilizing this maintenance approach.
Lurbinectedin has been used for ES-SCLC in the second-line and later settings for several years, and the toxicities are well understood. In IMforte, lurbinectedin was associated with nausea, fatigue, and cytopenias.
Some more rare side effects, like rhabdomyolysis, were also reported, Dr. Preeshagul said. However, most adverse events in patients treated with lurbinectedin were grade 1 or 2, and very few patients stopped treatment due to toxicity, Dr. Liu noted.
Holding the dose and then reducing it upon treatment reinitiation can be effective for managing adverse events that develop during treatment. Additionally, granulocyte colony-stimulating factor (G-CSF) support was used in IMforte as primary prophylaxis for neutropenia, and most patients continued G-CSF during maintenance.