Patient Scenario 3: 2L Lurbinectedin Following 1L Combination IO Chemotherapy

Transcript:

Taofeek K. Owonikoko, MD, PhD: In the next 30 minutes, I want us to focus a little bit more on second-line [treatment], our post-frontline setting. Dr [Jacob] Sands will walk us through a case illustration to guide the discussion.

Jacob Sands, MD: This is a 78-year-old patient who was initially admitted for weight loss and dysphasia. [She] ultimately had symptoms that were really due to something else, but incidentally noted to have a right upper lobe mass that was seen on the CT scan. PET [positron emission tomography] scan showed a significant FDG [fluorodeoxyglucose] avidity in the mass and a 4R node, and the biopsy showed small cell lung cancer. She was initially treated for limited-stage disease and ended up getting carboplatin and etoposide concurrent with radiation from October to December. The recurrence was noted in July. So this is about 7 months after [she was] treated, was insistent about being as aggressive as possible. And I remember the discussion with her where we talked about other lines of therapy and carboplatin, etoposide, and atezolizumab [Tecentriq] was really the most aggressive of those. This is a 7-month interval from when she completed the chemoradiation. What does the chemotherapy-free interval mean when you’re after chemoradiation? That’s a little different than the first-line setting, but we discussed it, and she was really quite insistent about this. So we proceeded. On this, she actually ended up with multiple urinary tract infections, had a hospitalization for pseudogout but did complete the 4 cycles of chemo [chemotherapy] and atezolizumab before then starting maintenance atezolizumab. She then ended up having progression again in January. This is a chemotherapy-free interval less than 3 months after the initiation of the carbo [carboplatin], etopo [etoposide], atezo [atezolizumab] started, about 5.5 months after having initiated the treatment with carbo, etopo, [and] atezo. In this setting then we started lurbinectedin [Zepzelca], 3.2 mg/m2, which we’ll discuss that dose in January. In April, she was admitted to the hospital for abdominal pain, unrelated to her diagnosis or treatment, had acute cholecystitis, and underwent laparoscopic cholecystectomy. Of course, was complicated by C Diff [clostridium difficile] severe colitis. So that prolonged the hospitalization a bit. After the hospitalization, [she] then went back on the lurbinectedin as she was recovering. And I highlight those in part to just show this was a complicated course for an older patient. While on lurbinectedin, these complications, I would not attribute to the treatment or the disease, but even recovering from that, we were able to reinitiate the lurbinectedin. [She] ultimately had progression on that, and the lurbinectedin was stopped. Just to highlight then, the carbo [carboplatin]/etopo [etoposide] with radiation had about 9 months of disease control, and then carbo [carboplatin]/etopo [etoposide]/atezo [atezolizumab] had about 5.5 months of disease control. But on lurbinectedin, she got about 8 months [of disease control]. So [disease control] got a bit longer from the lurbinectedin than she did from the carboplatin, etoposide, and atezolizumab.

Taofeek K. Owonikoko, MD, PhD: It should be highlighted, especially for a 78-year-old, that it takes real partnership with the patient to make this happen. And it’s quite impressive that the patient stayed so long on the lurbinectedin.

Transcript edited for clarity.