Real-world use, effectiveness, and safety of second-line lurbinectedin monotherapy in small cell lung cancer

Assess real-world outcomes of lurbinectedin and other second-line treatments (OST) in adults with small cell lung cancer that progressed on/after chemotherapy. US-based electronic medical data from Flatiron Health (01/01/2013–03/31/2022) were used. Baseline characteristics, including chemotherapy-free interval (CTFI), in patients receiving lurbinectedin or OST were balanced using propensity score (PS) overlap weighting. Before PS-weighting, median (95% confidence interval [CI]) real-world progression-free survival (rwPFS) was 2.46 months (2.07–2.73), and real-world response rate (rwRR) was 27.5% (23.1–32.4) in 374 eligible lurbinectedin-treated patients. After PS-weighting, median rwPFS was 2.73 months (2.33–3.32) and 2.53 months (2.23–2.99) in 291 lurbinectedin-treated patients and 261 OST-treated patients, respectively; rwRR was 30.9% and 31.8% (relative risk, 0.97). Lurbinectedin demonstrated numerically improved median rwPFS (3.61 versus 3.02 months) and rwRR (38.7% versus 36.1%) versus OST in patients with CTFI ≥90 days but not in patients with CTFI &lt;90 days (2.00 months both; 20.5% versus 26.1%). Lurbinectedin-treated patients reported less grade ≥3 thrombocytopenia (11.7%) and anemia (6.5%) versus OST (27.2% and 20.3%, respectively); prevalence by CTFI status were similar. Lurbinectedin demonstrated comparable real-world effectiveness with OST with a favorable safety profile; however, these findings are limited by small sample size. <b>What is this summary about?</b> Subsequent therapies for treatment-resistant small cell lung cancer (SCLC) are chosen based on how long it takes the cancer to worsen after completing platinum‑containing chemotherapy. Lurbinectedin is an available treatment for adult patients whose SCLC has spread to other body parts during or after platinum-containing chemotherapy. This study measured the effectiveness of lurbinectedin and other treatments in patients with extensive-stage SCLC using anonymous US-based electronic medical records. <b>What were the results?</b> This study found lurbinectedin had similar effectiveness compared with other treatments for extensive-stage SCLC. It took an average of 2.7 months before disease worsened in lurbinectedin-treated patients, and an average of 2.5 months before disease worsened in those receiving other treatments. About one in three patients had their tumors shrink or disappear with lurbinectedin or other treatments, regardless of treatment received, with this effect lasting 5–6 months on average. Patients whose disease worsened at 90 days or later after completing platinum-containing chemotherapy had better outcomes with lurbinectedin compared with other treatments. However, patients whose disease worsened within 90 days may have better outcomes with other treatments compared with lurbinectedin. Overall, fewer lurbinectedin-treated patients had severe or life-threatening blood-related side effects than patients receiving other treatments. Patients may be able to stay on lurbinectedin regardless of how long their tumors stopped growing after chemotherapy. <b>What do the results mean?</b> Lurbinectedin can be an appropriate treatment option to slow tumor growth for patients with extensive-stage SCLC, especially patients whose cancer progressed 90 days or more after platinum-containing chemotherapy. A PDF version of this infographic is available as supplemental material.