Sequencing Lurbinectedin in ES-SCLC with CNS Involvement

Ticiana Leal, MD Winship Cancer Institute of Emory University | Stephen Liu, MD Georgetown Lombardi Comprehensive Cancer Center | Rahul Gosain, MD, MBA Wilmot Cancer Institute | Rohit Gosain, MD Roswell Park Comprehensive Cancer Center

October 17, 2025

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Key Points

  • Available data do not support that lurbinectedin has activity in the central nervous system (CNS) among patients with extensive-stage small cell lung cancer (ES-SCLC).

  • Additional radiation therapy should be considered for patients with brain metastases prior to initiating maintenance regimens.

  • Lurbinectedin may still be valuable as part of an intensified maintenance approach in this higher-risk patient population.

Is Lurbinectedin Appropriate for Patients With Brain Metastases?

The IMforte trial led to the approval of lurbinectedin plus atezolizumab for maintenance therapy in patients with ES-SCLC in the first-line setting. In a roundtable discussion held on the Oncology Brothers podcast, cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, spoke with three thoracic oncologists about the applicability of the trial’s findings for patients with central nervous system (CNS) involvement.

Lurbinectedin has been used for ES-SCLC treatment in later-line settings for several years, and available data do not suggest it has significant CNS activity, said Stephen Liu, MD, of Georgetown Lombardi Cancer Center. IMforte and its predecessor trial IMpower133 both excluded patients with CNS metastases, though the IMforte protocol allowed for the use of prophylactic cranial radiation for up to 9 weeks in between the end of induction and the start of maintenance.

Additional radiation therapy should be prioritized for patients with active brain metastases, but the lurbinectedin maintenance regimen may still be a valuable treatment approach. “Those patients, if anything, I think are at higher risk for relapse, and potentially more likely to get a benefit from a more aggressive maintenance strategy,” Dr. Liu said.