Dr. Pellini on the Challenges of Using Topotecan as a Comparator Arm in Recurrent ES-SCLC

Bruna Pellini, MD, assistant member, Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, assistant professor, Morsani College of Medicine, University of South Florida, discusses the challenges of using topotecan as a comparator arm for second-line clinical trials in extensive-stage small cell lung cancer (ES-SCLC).

A majority of clinical trials evaluating therapies for the second-line treatment of patients with ES-SCLC utilize topotecan as the comparator arm, says Pellini. However, topotecan is rarely given to patients in practice, Pellini explains.

Lurbinectedin (Zepzelca) is a well-tolerated transcription factor inhibitor that was approved in June 2020 by the FDA for the treatment of patients with metastatic SCLC who have disease progression after platinum-based chemotherapy. The agent is administered every 3 weeks, whereas topotecan is administered on days 1 through 5 of 21-day cycles, Pellini says. Additionally, topotecan is associated with more toxicity compared with lurbinectedin, Pellini says.

Although lurbinectedin is a relatively new agent in the SCLC armamentarium, the agent could offer another option for comparison against investigational agents in clinical trials, Pellini says. Other chemotherapy options are available in the second-line setting for this patient population; however, these agents are also associated with significant toxicity, Pellini says. Ultimately, lurbinectedin could offer patients a well-tolerated and easy-to-administer regimen following platinum-based doublet therapy, concludes Pellini.