Is Zepzelca Right for You? A Guide to Treatment, Cost, and Safety

If you are living with small-cell lung cancer and chemotherapy has not been effective, a new treatment called Zepzelca may be an option for you. Studies suggest Zepzelca can be more effective in treating small-cell lung cancer (SCLC) than other currently available medications in specific scenarios. In this article, we will explore everything you need to know about Zepzelca, including its dosing, side effects, cost, and more.

What Is Zepzelca?

Zepzelca (lurbinectedin) is an FDA-approved chemotherapy medication used to treat small-cell lung cancer. The FDA first approved this medication on June 15, 2020 [1]. If your cancer has spread to other parts of your body and other medications (e.g., platinum-based chemotherapy) haven’t worked well, ask your oncologist if Zepzelca is right for you. 

Zepzelca is a chemotherapy medication called an alkylating agent. It works by attaching to the DNA (genetic material) of the cancer cells to stop their ability to grow and multiply. Zepzelca is given through an infusion through the veins (intravenous or IV), which takes about 1 hour. Some common side effects include tiredness, diarrhea, nausea, and constipation.

When Can You Use Zepzelca?

You can use Zepzelca when your small-cell lung cancer has:

• Spread to other parts of your body
• Gotten worse after you had other treatments like platinum-based chemotherapy

Keep in mind that the FDA approved this medication quickly based on how well it worked and how long the benefits lasted. However, its continued approval depends on further studies.

How Does It Work?

Zepzelca is an alkylating agent. It attaches to a specific part of the DNA of cancer cells and stops them from replicating. As a result, the cancer cells aren’t able to multiply, and they eventually die [2].

Side Effects

Like any other medication, Zepzelca can have some side effects [3].

Common Side Effects

Common side effects include:

• Diarrhea
• Trouble Breathing
• Nausea
• Tiredness
• Low levels of sodium and magnesium in the blood
• Constipation
• Low white and red blood cell counts
• Low level of albumin in the blood
• Decreased appetite
• Increased kidney and liver function blood test
• Increased blood sugar
• Muscle and joint pain
• Cough and vomiting

Severe Side Effects

Severe side effects include:

Severe Neutropenia: In this condition, your white blood cell levels become abnormally low. This raises your chance of getting life-threatening infections. During your treatment, your provider will regularly monitor your white blood cell counts. If your white blood cells become too low, your provider may adjust your dose or delay treatment.

Liver Problems: Zepzelca can damage your liver. Symptoms of liver problems include loss of appetite, pain on the right side of your stomach, and nausea or vomiting. Liver function tests (LFTs) are blood results that can indicate how healthy your liver is. Your provider will regularly monitor your LFTs during Zepzelca treatment to make sure your liver is healthy.

Severe Muscle Problems: Zepzelca can cause severe muscle pain or weakness. Inform your provider immediately if you encounter these symptoms. 

Leakage of Zepzelca Out of Your Vein During the Infusion: If Zepzelca leaks out of your vein during the infusion, it can damage the surrounding tissue and cause tissue death. If this happens, you will need urgent treatment at a hospital. During the infusion, if you see any Zepzelca leaking out of your vein or feel sudden pain or burning around the infusion site, tell your provider immediately.

Please note that this is not a list of all possible side effects. If you encounter any severe side effects, consult your provider immediately.

What Are the Clinical Benefits of Zepzelca?

A clinical study was conducted on 105 patients with small-cell lung cancer (SCLC) whose cancer got worse after receiving platinum-based chemotherapy. All the patients received Zepzelca in the study. Researchers found that 35% of all patients receiving Zepzelca saw a reduction in their tumor size, with a median response of 5.3 months [1]. Compared to traditional medications, Zepzelca was more effective.

Dosing Information

You can get Zepzelca as an intravenous infusion. The infusion takes about an hour to complete. You may also receive some anti-nausea medications shortly before the infusion to help prevent nausea. The dose of Zepzelca is based on your body surface area. The usual dose is 3.2 mg/m² given once every 21 days. You will continue receiving this treatment until your cancer worsens or you experience bothersome or serious side effects [2].

Your provider will determine the right dosage for you based on your specific clinical situation. So, always follow your provider’s advice. Your prescriber will also regularly monitor you during treatment to manage any side effects you might be experiencing.

Before Receiving Zepzelca

Before you start your treatment with Zepzelca:

• Tell your provider if you are allergic to lurbinectedin or any of the ingredients in lurbinectedin injection.
• Inform your provider if you are pregnant or want to become pregnant. Zepzelca may harm your unborn baby, so it shouldn’t be taken during pregnancy. If you are a female, able to become pregnant, and are receiving Zepzelca, you should use birth control during the treatment and for 6 months after the final dose. If you are a male, are receiving Zepzelca, and have a female partner that’s able to get pregnant, you should use birth control during the treatment and for 4 months after the final dose.
• Tell your provider all of your medical history. Inform them about all the medications that you are currently taking, including over-the-counter and herbal medications.
• Inform your provider if you are breastfeeding. You should not breastfeed during treatment and for at least 2 weeks after your final dose due to potential harm and side effects to your baby.

Zepzelca Cost

Zepzelca is available as a powder for injection, with a strength of 4 mg per vial. The cost can vary significantly based on your location, treatment plan, insurance coverage, and the pharmacy you visit. However, on average, each vial of Zepzelca costs around $6,470 [4]. So, the overall treatment cost is very high. Before beginning your treatment, you should consult your provider and health insurance company about the cost. You should also explore various financial assistance programs.

FAQs

Here are some frequently asked questions about Zepzelca:

1. Does Zepzelca cause hair loss?

Yes. Hair loss is a side effect of Zepzelca. In clinical trials, about 1% of patients receiving Zepzelca experienced hair loss [5]. If you experience hair loss during your treatment, consult your prescriber for possible remedies.

2. Can I use Zepzelca if I have liver problems?

If you have mild liver problems, then you can use Zepzelca. There is no need for dosage adjustments. However, there is still no data on patients with moderate to severe liver problems [2]. In such cases, you should consult your provider for further information.

3. What should I avoid while taking Zepzelca?

While taking this medication, you should take some precautions and avoid certain things to minimize side effects:

• Zepzelca can weaken your immune system. This makes you more likely to get infections. So, to decrease your chance of getting infections, you should avoid close contact with people who are sick and practice good hygiene. 
• You should avoid drinking alcohol. Alcohol can interfere with your liver. Since Zepzelca is processed through the liver, avoiding alcohol can help prevent liver-related complications.
• You should avoid eating or drinking anything that contains grapefruit or Seville oranges. These products can raise the levels of Zepzelca in your body, which can raise your risk for side effects.