Zepzelca (Lurbinectedin) - Intravenous

What Is Zepzelca?

Zepzelca (lurbinectedin) is a prescription, intravenous (injected into the veins) medication that's used to treat a type of lung cancer in adults called small cell lung cancer (SCLC). 

SCLC is the most aggressive type of lung cancer, affecting over 30,000 people each year in the United States. Lurbinectedin works by disrupting the DNA and the function of cancer cells, causing the tumor cells to die. 

Zepzelca is not on the National Institute for Occupational Safety & Health (NIOSH) list. It is, however, a cytotoxic (toxic to cells) and hazardous drug. This injectable is only available with a prescription and may only be administered by a trained healthcare provider.

Drug Facts

Generic Name: Lurbinectedin

Brand Name(s): Zepzelca

Drug Availability: Prescription

Therapeutic Classification: Antineoplastic Agent, Alkylating Agent

Available Generically: No

Controlled Substance: N/A

Administration Route: Intravenous

Active Ingredient: Lurbinectedin

Dosage Form(s): Injectable

What Is Zepzelca Used For?

Zepzelca (lurbinectedin) is an injectable chemotherapy drug that treats metastatic (spreading) small cell lung cancer (SCLC) in adults. SCLC is most prevalent in people who smoke tobacco. Lurbinectedin may be combined with other chemotherapy drugs to treat cancer in adults.

Zepzelca (Lurbinectedin) Drug Information - A person's chest showing areas affected

Verywell / Dennis Madamba

How to Use Zepzelca

Your healthcare provider may order this medicine only if your absolute neutrophil count (ANC), a type of white blood cell, is at least 1,500/cubic millimeters (mm3). In addition, your platelets, which help your blood clot effectively, must also be at least 100,000/cubic millimeters (mm3) before starting this medicine.

Zepzelca is mixed and infused over 60 minutes once every 21 days as determined by your healthcare provider. This drug is a vesicant. It may cause blisters, swelling, or damage to your skin. Your trained healthcare provider must ensure that the needle or catheter is placed correctly before and during drug infusion. Correct placement avoids extravasation (spilling out of the drug from the veins).

Note: Zepzelca (lurbinectedin) has a high tendency to cause nausea. The following medicines have been used to help manage nausea symptoms: Zofran (ondansetron, an anti-nausea medication), dexamethasone (a corticosteroid), Benadryl (diphenhydramine, an antihistamine), and even concentrated ginger. Please talk to your healthcare provider, however, before taking any medicines to treat symptoms of nausea to make sure that they are the right fit for you.

Storage

Store unopened vials in the refrigerator (between 36 and 46 degrees Fahrenheit). Once reconstituted or diluted, store the solution for up to 24 hours (including infusion time) at room temperature in ambient light or in the refrigerator.

How Long Does Zepzelca Take to Work?

Zepzelca is infused into the veins and may begin to work almost immediately.

What Are the Side Effects of Zepzelca?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects of Zepzelca include but are not limited to:

Severe Side Effects

Zepzelca can cause many side effects. Some may be life-threatening. Call your healthcare provider promptly if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Severe side effects include:

  • Coughing up blood
  • Ear or sinus pain
  • Fever
  • Pale skin
  • Numbness
  • Chest pain
  • Tissue/skin damage
  • Bone marrow suppression
  • Gastrointestinal problems
  • Liver issues


Note: This is not a full list of all possible adverse effects. If you have any concerns, consult your healthcare provider.

Long-Term Side Effects

Extravasation: When Zepzelca is not infused correctly, it may leak out of the veins and sometimes cause irreversible skin damage (extravasation). If extravasation happens, your healthcare provider must stop and disconnect the infusion immediately, leaving the needle or cannula in place. They must gently draw up the extravasated solution. Your healthcare provider will remove the needle or cannula and elevate your limb. Do not flush the line. If a further infusion is required, your healthcare provider will give your infusion through an intact area that's not been affected by extravasation.

Tumor lysis syndrome: Zepzelca may be associated with tumor lysis syndrome, a situation in which many cancer cells die in a short amount of time, spilling their contents into the bloodstream. This syndrome causes a series of symptoms, including kidney failure and death.

Report Side Effects

Zepzelca may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Zepzelca Should I Use?

Your healthcare provider will determine and administer the proper dosage of Zepzelca for you.

Modifications

The following modifications (changes) should be kept in mind when using Zepzelca (lurbinectedin):

Pregnancy: Data available shows that lurbinectedin may be harmful to a fetus. Hence, use effective birth control while on this drug and for six months after the last lurbinectedin dose. If your partner may become pregnant, use an adequate contraceptive while using this medicine and for four months after the last dose of lurbinectedin.

Breastfeeding: Due to the potential risk of harm to breastfed infants, avoid breastfeeding during treatment and for two weeks after the last lurbinectedin dose. Talk with your healthcare provider or your child's pediatrician about different ways to feed your baby during this time.

Adults over the age of 65 years: This population may have a higher chance of experiencing severe side effects. Some common side effects reported in this age group include:

Children: The safety and effectiveness of Zepzelca in children have not been established.

Weight: If you experience drug toxicity while on this medicine, your healthcare provider may adjust your dose based on your weight. In some cases, lurbinectedin may be permanently discontinued. Speak to your healthcare provider if you are experiencing any severe or toxic side effects.

Missed Dose

It is recommended that you do not miss any doses of this medicine. Contact your healthcare provider on what you should do if you miss a dose.

Try to find ways to help yourself remember to routinely get your infusions. If you miss too many doses, Zepzelca might be less effective at treating your lung cancer.

Overdose: What Happens If I Take Too Much Zepzelca?

There is limited information available about Zepzelca overdose.

However, if you think that you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

What Happens If I Overdose on Zepzelca?

If you think you or someone else may have overdosed on Zepzelca, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Zepzelca, call 911 immediately.

Precautions

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It is very important that your doctor check your progress closely while you are receiving this medicine. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to receive it. Blood and urine tests may be needed to check for unwanted effects.

Receiving this medicine while you are pregnant can harm your unborn baby. If you are a woman who can bear children, your doctor may give you a pregnancy test before you start receiving this medicine to make sure you are not pregnant. This medicine may also cause birth defects if the father is receiving it when his sexual partner becomes pregnant. Female patients should use an effective form of birth control during treatment and for at least 6 months after the last dose. Male patients who have female partners should use effective birth control during treatment and for at least 4 months after the last dose. If you think you have become pregnant or your partner has become pregnant while receiving this medicine, tell your doctor right away.

This medicine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you get a fever, chills, cough, hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Zepzelca?

The manufacturer lists no contraindications. However, do not use this medicine if you're allergic to Zepzelca or any of its ingredients.

What Other Medications Interact With Zepzelca?

Certain medications interact with Zepzelca and increase the risk of severe side effects or decrease how well it works. Use caution when taking Zepzelca with the following medications:

CYP3A Inhibitors like:

For more detailed information about medication interactions with Zepzelca, talk with your pharmacist or healthcare provider.

What Medications Are Similar?

Other drugs similar to Zepzelca that are antineoplastic, retinoic acid derivatives include:

This list lists drugs also prescribed to treat small cell lung cancer. It is NOT a list of drugs suggested to take with Zepzelca. You should not take these drugs together unless your healthcare provider tells you to. Ask your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Zepzelca used to treat?

    Zepzelca is used to treat small cell lung cancer in adults.

  • What are the common side effects of Zepzelca?

    Some common side effects include:

     

    • Stomach pain 
    • Loss of appetite
    • Signs of the common cold
    • Nausea/Vomiting
    • Muscle or joint pain
    • Feeling tired or weak
    • Constipation
    • Headache
    • Diarrhea
  • Can I breastfeed while on Zepzelca?

    Due to the potential risk of harm to your infant, do not breastfeed while on this drug and for at least two weeks after your last dose. Talk to your healthcare provider or your child's pediatrician about ways to feed your baby during this time.

How Can I Stay Healthy While Taking Zepzelca?

Going through chemotherapy as you battle with lung cancer can be difficult. However, there are ways to help improve your quality of life. Refer below for some general tips to support your health:

  • Take your medicines as recommended by your healthcare provider.
  • Avoid smoking or being around secondhand smoke.
  • Maintain a healthy diet and exercise as directed by your healthcare provider. Consider working with a registered dietitian nutritionist (RD or RDN) that specializes in cancer nutrition treatment. They can help you effectively manage symptoms that may impact your quality of life during treatment like unwanted weight loss or nausea.
  • Do not start, stop or adjust any medicine, including over-the-counter medicines, supplements, or plant-based medicines, without talking to your healthcare provider.
  • Use all resources available to you, including support groups. Find support groups near you through resources like the American Lung Association and Cancer Care.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Zepzelca label.

  2. Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer. 2015;121(5):664-672. doi:10.1002/cncr.29098

  3. Trigo J, Subbiah V, Besse B, et al. Lurbinectedin as second-line treatment for patients with small-cell lung cancer: a single-arm, open-label, phase 2 basket trial. Lancet Oncol. 2020;21(5):645-654. doi:10.1016/S1470-2045(20)30068-1

  4. Wahab A, Rafae A, Mushtaq K, Venkata K, Sarmad R. Lurbinectedin-induced tumor lysis syndrome in small cell neuroendocrine cancer of the cecum: a first-ever case report. Am J Case Rep. 2021;22. doi:10.12659/AJCR.932081

  5. Yang S, Zhang Z, Wang Q. Emerging therapies for small cell lung cancer. J Hematol Oncol. 2019;12(1):47. doi:10.1186/s13045-019-0736-3

By Queen Buyalos, PharmD
Queen Buyalos is a pharmacist and freelance medical writer. She takes pride in advocating for cancer prevention, overall health, and mental health education. Queen enjoys counseling and educating patients about drug therapy and translating complex ideas into simple language.