Zepzelca Injection: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Zepzelca Injection (lurbinectedin) is a chemotherapy medicine from the alkylating agent class, given by IV infusion. It is used in adults with small cell lung cancer (SCLC) that has spread or kept growing after other treatments. It works by damaging the DNA inside cancer cells, causing them to die. Zepzelca is given as an infusion, typically once every 21 days, with monitoring for side effects such as low blood cell counts and liver problems.

What is Zepzelca Injection

Zepzelca is a chemotherapy medicine given by IV infusion. It is used for adults with small cell lung cancer (SCLC) that has spread or kept growing after other treatments.

Zepzelca Injection uses

• Treatment of adults with metastatic small cell lung cancer (SCLC) whose disease has gotten worse during or after platinum-based chemotherapy
• Used together with atezolizumab (or atezolizumab and hyaluronidase-tqjs) as maintenance treatment for extensive-stage SCLC that has not gotten worse after first treatment with atezolizumab plus carboplatin and etoposide

Benefits of Zepzelca Injection

In a clinical study of 105 patients with SCLC who had worsened after platinum-based chemotherapy, 35% of patients had their tumors shrink, with this effect lasting a median of 5.3 months.

How Zepzelca Injection works

Zepzelca attaches to the DNA inside cancer cells, causing the DNA to bend and become damaged. This disrupts how the cancer cells function and repair themselves, eventually causing the cells to die. It may also reduce certain immune cells in tumors that can help cancer grow.

Zepzelca Injection dosage

Zepzelca is given as an intravenous (IV) infusion into a vein over about 60 minutes, usually once every 21 days. You may be given medicines before each treatment to help prevent nausea and vomiting. Your healthcare provider will decide how long your treatment will continue, based on how your cancer responds and how you tolerate side effects. Your healthcare provider will do blood tests during treatment to check for side effects and see how well the treatment is working. Avoid eating or drinking grapefruit, Seville oranges, or products containing them during treatment.

Available forms and strengths

Injection

Side effects of Zepzelca Injection

Common

• Tiredness
• Nausea
• Decreased appetite
• Constipation
• Vomiting
• Diarrhea
• Cough
• Trouble breathing
• Muscle and joint pain
• Low white and red blood cell counts
• Increased kidney function blood test (creatinine)
• Increased liver function blood tests
• Increased blood sugar (glucose)
• Low level of albumin in the blood
• Low levels of sodium and magnesium in the blood

Serious

• Low blood cell counts (neutropenia, thrombocytopenia) that can lead to serious infection or sepsis
• Liver problems (hepatotoxicity)
• Leakage of the medicine out of the vein during infusion, causing tissue damage or death (extravasation/necrosis)
• Severe muscle problems (rhabdomyolysis)
• Serious allergic reactions

Warnings and precautions

• Zepzelca can cause low blood cell counts (low neutrophils and platelets), which can lead to serious infections such as sepsis that can be fatal. Blood counts are checked before each treatment.
• Zepzelca can cause liver damage. Liver function tests are done before and during treatment.
• If Zepzelca leaks out of the vein during infusion, it can damage and kill the surrounding tissue, possibly requiring surgery to remove dead tissue.
• Zepzelca can cause severe muscle breakdown (rhabdomyolysis), which can cause muscle pain or weakness.
• Avoid grapefruit, Seville oranges, and products containing them, as they can raise Zepzelca levels in the body and increase side effects.
• Zepzelca can harm an unborn baby. A pregnancy test should be done before starting treatment. Women who can become pregnant should use effective birth control during treatment and for 6 months after the last dose. Men with partners who can become pregnant should use effective birth control during treatment and for 4 months after the last dose.
• It is not known if Zepzelca passes into breast milk. Women should not breastfeed during treatment and for 2 weeks after the last dose.
• Tell your healthcare provider if you have kidney problems before starting Zepzelca.
• Zepzelca can cause liver problems. Liver function should be checked before starting and during treatment, and the dose may need to be reduced or treatment avoided in people with moderate or severe liver impairment.
• It is not clearly known if alcohol affects Zepzelca, but heavy drinking can weaken the immune system and may make it harder for the body to fight cancer.
• Zepzelca can cause tiredness and loss of strength. Do not drive or use tools or machines if you experience these side effects.

Storage

• Store refrigerated at 2°C to 8°C (36°F to 46°F)
• This medicine is a hazardous drug; special handling and disposal procedures should be followed
• If not used right away after mixing, the prepared solution can be kept for up to 24 hours (including infusion time) at room temperature or refrigerated

When to see a doctor

• Contact your healthcare provider right away if you develop fever, signs of infection, unusual bruising or bleeding, tiredness, or pale skin.
• Contact your healthcare provider right away if you develop loss of appetite, nausea or vomiting, or pain on the right side of your abdomen, which may be signs of liver problems.
• Tell your healthcare provider right away if you notice the medicine leaking from your vein, or see redness, swelling, itching, or discomfort at the infusion site.
• Tell your healthcare provider if you have severe muscle pain or weakness.
• Tell your healthcare provider right away if you become pregnant or think you might be pregnant during treatment.

Alternatives

• Lurbinectedin
• Topotecan