Indirect treatment comparison of lurbinectedin versus other second-line treatments for small-cell lung cancer
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: Compare lurbinectedin versus other second-line (2L) small-cell lung cancer (SCLC) treatments. Methods: An unanchored matching-adjusted indirect comparison connected the platinum-sensitive SCLC cohort of a single-arm lurbinectedin trial to a network of three randomized controlled trials (oral and intravenous [IV] topotecan, and platinum re-challenge) identified by systematic literature review. Network meta-analysis methods estimated relative treatment effects. Results: In platinum-sensitive patients, lurbinectedin demonstrated a survival benefit and favorable safety profile versus oral and IV topotecan and platinum re-challenge (overall survival, hazard ratio [HR]: 0.43; 95% credible interval [CrI]: 0.27, 0.67; HR: 0.43; 95% CrI: 0.26, 0.70; HR: 0.42; 95% CrI: 0.30, 0.58 respectively). Conclusion: Lurbinectedin showed a robust survival benefit and favorable safety versus other SCLC treatments in 2L platinum-sensitive SCLC.
Tweetable abstract
Indirect treatment comparison analysis demonstrates robust survival benefit and safety profile for lurbinectedin monotherapy versus relevant comparators (oral and intravenous topotecan; platinum re-challenge) as second-line therapy for platinum-sensitive small-cell lung cancer
Supplementary Material
File (supplementary materials.docx)
- Download
- 1.96 MB
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer 121(5), 664–672 (2015).
2.
Van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet 378(9804), 1741–1755 (2011).
3.
National Cancer Comprehensive Network. Small Cell Lung Cancer, Version 2.2023. In: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) (2022). www.nccn.org
4.
Augert A, Macpherson D. Treating transcriptional addiction in small cell lung cancer. Cancer Cell 26(6), 783–784 (2014).
5.
American Cancer Society. Cancer Facts & Figures 2022. American Cancer Society, GA, USA (2022).
6.
Chan BA, Coward JI. Chemotherapy advances in small-cell lung cancer. J Thorac Dis 5(Suppl. 5), S565–S578 (2013).
7.
Simon GR, Turrisi A. Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(Suppl. 3), 324S–339S (2007).
8.
Früh M, De Ruysscher D, Popat S, Crino L, Peters S, Felip E. Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 24(Suppl. 6), vi99–105 (2013).
9.
Rudin CM, Ismaila N, Hann CL et al. Treatment of small-cell lung cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians Guideline. J. Clin. Oncol. 33(34), 4106–4111 (2015).
10.
Micke P, Faldum A, Metz T et al. Staging small cell lung cancer: Veterans Administration Lung Study Group versus International Association for the Study of Lung Cancer–what limits limited disease? Lung Cancer 37(3), 271–276 (2002).
11.
Udyavar AR, Hoeksema MD, Clark JE et al. Co-expression network analysis identifies Spleen Tyrosine Kinase (SYK) as a candidate oncogenic driver in a subset of small-cell lung cancer. BMC Syst Biol 7(5), S1 (2013).
12.
Li L, Li W, Chen N et al. FLI1 exonic circular RNAs as a novel oncogenic driver to promote tumor metastasis in small cell lung cancer. Clin Cancer Res 25(4), 1302–1317 (2019).
13.
George J, Lim JS, Jang SJ et al. Comprehensive genomic profiles of small cell lung cancer. Nature 524(7563), 47–53 (2015).
14.
Manzo A, Sforza V, Carillio G et al. Lurbinectedin in small cell lung cancer. Front Oncol 12, 932105 (2022).
15.
Hurwitz JL, Mccoy F, Scullin P, Fennell DA. New advances in the second-line treatment of small cell lung cancer. Oncologist 14(10), 986–994 (2009).
16.
Gong J, Salgia R. Managing patients with relapsed small-cell lung cancer. J Oncol Prac 14(6), 359–366 (2018).
17.
Moser SS, Bar J, Kan I et al. Real world analysis of small cell lung cancer patients: prognostic factors and treatment outcomes. Curr Oncol 28(1), 317–331 (2021).
18.
Belgiovine C, Bello E, Liguori M et al. Lurbinectedin reduces tumour-associated macrophages and the inflammatory tumour microenvironment in preclinical models. Br. J. Cancer 117(5), 628–638 (2017).
19.
Jazz Pharmaceuticals Lurbinectedin (Zepzelca) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213702s000lbl.pdf (Accessed 4 July 2020).
20.
Jazz Pharmaceuticals Announces U.S. FDA Accelerated Approval of Zepzelca™ (lurbinectedin) for the Treatment of Metastatic Small Cell Lung Cancer. https://www.prnewswire.com/news-releases/jazz-pharmaceuticals-announces-us-fda-accelerated-approval-of-zepzelca-lurbinectedin-for-the-treatment-of-metastatic-small-cell-lung-cancer-301077082.html (Accessed 4 July 2020).
21.
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 II basket trial. Lancet Oncol 21(5), 645–654 (2020).
•• Presents data from the basket trial (Study B-005) which was utilized to conduct the study described in this paper.
22.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J. Clin. Epidemiol. 62(10), 1006–1012 (2009).
23.
NIH National Cancer Institute Drugs Approved for Small Cell Lung Cancer. https://www.cancer.gov/about-cancer/treatment/drugs/lung#3 (Accessed 4 July 2020).
24.
Phillippo D, Ades A, Dias S, Palmer S, Abrams K, Welton K. NICE DSU Technical support document 18: methods for population-adjusted indirect comparisons in submissions to NICE. (2016).
• Describes the methods for matching-adjusted indirect comparisions that were used in the analyses described in this paper.
25.
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat. Med. 28(25), 3083–3107 (2009).
• Describes the methods that were used to identify the best matching trial in the analyses described in this paper.
26.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat. Med. 34(28), 3661–3679 (2015).
• Describes the methods that were used to identify the best matching trial in the analyses described in this paper.
27.
Dias S, Welton NJ, Sutton AJ, Ades AE. NICE DSU Technical Support Document 2: A Generalised Linear Modelling Framework for Pairwise and Network Meta-Analysis of Randomised Controlled Trials. National Institute for Health and Clinical Excellence, Royston, UK (2011).
28.
Dias S, Ades AE, Welton NJ, Jansen JP, Sutton AJ. Network Meta-Analysis of Survival Outcomes. In: Network Meta-Analysis for Decision-Making. Wiley, 293–322 (2018).
29.
Grambsch PM, Therneau TM. Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81(3), 515–526 (1994).
30.
Jansen JP. Network meta-analysis of survival data with fractional polynomials. BMC Med Res Methodol 11(1), 61 (2011).
31.
Ouwens MJ, Philips Z, Jansen JP. Network meta-analysis of parametric survival curves. Res Synth Methods 1(3–4), 258–271 (2010).
32.
Jansen JP, Cope S. Meta-regression models to address heterogeneity and inconsistency in network meta-analysis of survival outcomes. BMC Med Res Methodol 12(1), 152 (2012).
33.
Baize N, Monnet I, Greillier L et al. Carboplatin plus etoposide versus topotecan as second-line treatment for patients with sensitive relapsed small-cell lung cancer: an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 21(9), 1224–1233 (2020).
•• Presents data from Baize 2020 which was utilized to conduct the study described in this paper.
34.
O'Brien ME, Ciuleanu TE, Tsekov H et al. Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J. Clin. Oncol. 24(34), 5441–5447 (2006).
• Presents data from O'Brien 2006 which was utilized to conduct sensitivity analysis no. 3 in this paper.
35.
Eckardt JR, Von Pawel J, Pujol JL et al. Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J. Clin. Oncol. 25(15), 2086–2092 (2007).
•• Presents data from Eckardt 2007 which was utilized to conduct the study described in this paper.
36.
Von Pawel J, Gatzemeier U, Pujol JL et al. Phase ii comparator study of oral versus intravenous topotecan in patients with chemosensitive small-cell lung cancer. J. Clin. Oncol. 19(6), 1743–1749 (2001).
•• Presents data from von Pawel 2001 which was utilized to conduct the study described in this paper.
37.
United Therapeutics. Dinutuximab and irinotecan versus irinotecan to treat subjects with relapsed or refractory small cell lung cancer. ClinicalTrials.gov identifier: NCT03098030. https://clinicaltrials.gov/ct2/show/NCT03098030 (Accessed January 2023).
38.
Owonikoko TK, Niu H, Nackaerts K et al. Randomized phase II study of paclitaxel plus alisertib versus paclitaxel plus placebo as second-line therapy for small-cell lung cancer: primary and correlative biomarker analyses. J Thorac Oncol 15(2), 274–287 (2020).
39.
Spigel DR, Vicente D, Ciuleanu TE et al. Second-line nivolumab in relapsed small-cell lung cancer: checkMate331. Ann. Oncol. 32(5), 631–641 (2021).
40.
Smyth JF, Smith IE, Sessa C et al. Activity of docetaxel (Taxotere) in small cell lung cancer. The Early Clinical Trials Group of the EORTC. Eur. J. Cancer 30A(8), 1058–1060 (1994).
41.
Antonia SJ, Lopez-Martin JA, Bendell J et al. Nivolumab alone and nivolumab plus ipilimumab in recurrent small-cell lung cancer (CheckMate 032): a multicentre, open-label, phase 1/2 trial. Lancet Oncol 17(7), 883–895 (2016).
42.
Ready NE, Ott PA, Hellmann MD et al. Nivolumab monotherapy and nivolumab plus ipilimumab in recurrent small cell lung cancer: Results From the CheckMate 032 Randomized Cohort. J Thorac Oncol 15(3), 426–435 (2020).
43.
Subbiah V, Paz-Ares L, Besse B et al. Antitumor activity of lurbinectedin in second-line small cell lung cancer patients who are candidates for re-challenge with the first-line treatment. Lung Cancer 150, 90–96 (2020).
44.
Baize N, Monnet I, Greillier L et al. OA15.02 Carboplatin-etoposide versus topotecan as second-line treatment for sensitive relapsed small-cell lung cancer: phase 3 trial. J Thorac Oncol 14(10), S246 (2019).
45.
Chen L, Antras L, Duh MS, Neary M, O'Brien ME. Symptom assessment in relapsed small cell lung cancer: cross-validation of the patient symptom assessment in lung cancer instrument. J Thorac Oncol 3(10), 1137–1145 (2008).
46.
Millenium Pharmaceuticals, Inc. Phase II study of alisertib (MLN8237) in combination with paclitaxel versus placebo in combination with paclitaxel as second line therapy for small cell lung cancer (SCLC). ClinicalTrials.gov identifier: NCT02038647. https://ClinicalTrials.gov/show/NCT02038647 (Accessed January 2023).
47.
Bristol-Meyers Squibb. Effectiveness study of nivolumab compared to chemotherapy in patients with relapsed small-cell lung cancer (CheckMate331). ClinicalTrials.gov identifier: NCT02481830. https://clinicaltrials.gov/ct2/show/NCT02481830 (Accessed January 2023).
48.
Trigo Perez JM, Subbiah V, Besse B et al. P1.12-03 Antitumor activity of single agent lurbinectedin in patients with relapsed SCLC occurring ≥30 days after last platinum dose. J Thorac Oncol 14(10), S535 (2019).
49.
PharmaMar S.A. Clinical study report: a multicenter phase II clinical trial of lurbinectedin (PM01183) in selected advanced solid tumors. Small cell lung cancer (SCLC) cohort. (ClinicalTrials.gov Identifier: NCT02454972). https://clinicaltrials.gov/ct2/show/NCT02454972 (Accessed January 2023).
50.
PharmaMar S.A. Addendum to the clinical study report: a multicenter phase II clinical trial of lurbinectedin (PM01183) in selected advanced solid tumors. Small cell lung cancer (SCLC) cohort. https://clinicaltrials.gov/ct2/show/NCT02454972 (Accessed January 2023).
51.
Jazz Pharmaceuticals. To assess the effectiveness and safety of Zepzelca in adult patients with extensive stage small cell lung cancer (SCLC). ClinicalTrials.gov identifier: NCT04894591. https://clinicaltrials.gov/ct2/show/NCT04894591 (Accessed January 2023).
52.
Das M, Padda SK, Weiss J, Owonikoko TK. Advances in treatment of recurrent small cell lung cancer (SCLC): insights for optimizing patient outcomes from an expert roundtable discussion. Adv Ther 38(11), 5431–5451 (2021).
53.
PharmaMar. Clinical Trial of Lurbinectedin as single-agent or in combination with irinotecan versus topotecan or irinotecan in patients with relapsed small-cell lung cancer (LAGOON). (ClinicalTrials.gov identifier: NCT05153239). https://clinicaltrials.gov/ct2/show/NCT05153239 (Accessed January 2023).
54.
Jazz Pharmaceuticals. Lurbinectedin monotherapy in participants with advanced or metastatic solid tumors. ClinicalTrials.gov identifier: NCT05126433. https://clinicaltrials.gov/ct2/show/NCT05126433 (Accessed January 2023).
55.
Hoffmann-LaRoche & Jazz Pharmaceuticals. A phase III, open-label study of maintenance lurbinectedin in combination with atezolizumab compared with atezolizumab in participants with extensive-stage small-cell lung cancer. ClinicalTrials.gov identifier: NCT05091567. https://clinicaltrials.gov/ct2/show/NCT05091567 (Accessed January 2023).
Information & Authors
Information
Published In
Copyright
© 2023 The Authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 1 June 2022
Accepted: 6 February 2023
Published online: 20 April 2023
Keywords:
Topics
Authors
Funding Information
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Indirect treatment comparison of lurbinectedin versus other second-line treatments for small-cell lung cancer. (2023) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2022-0098
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Jessie Wang, Rumbidzai Takundwa, Hongbo Yang, Xinglei Chai, Youfei Yu, Yuehan Zhang, Franziska Dirnberger, Erik S. Anderson, Malaika Pastel, Xerxes Pundole, Igor Gomez-Randulfe, Fiona Blackhall, Comparative efficacy of tarlatamab and second-line therapies in extensive-stage small cell lung cancer: A network meta-analysis, Lung Cancer, 10.1016/j.lungcan.2026.109465, 217, (109465), (2026).
- V. Andreas, M. Faltys, M. Alexander, J. Rogers, S. Parakh, S. Bowyer, L. Warburton, A. Fantoni, T. Clay, S. Arulananda, I. Sullivan, S. Kao, I. Da Silva, L.J. Brown, B.G.M. Hughes, M. Itchins, B. Solomon, T. John, Second-line treatment strategies and clinical outcomes after progression on chemoimmunotherapy in extensive-stage small-cell lung cancer, Lung Cancer, 10.1016/j.lungcan.2025.108786, 209, (108786), (2025).
- Apar Kishor Ganti, Ralph B. D’Agostino, Victoria Allan, Patricia Prince, Adina Estrin, Nileesa Gautam, Anne Boccuti, Badri Rengarajan, Wenyan Li, Yanyan Cao, Xiaozhou Fan, Elizabeth M. Poole, Real-world use, effectiveness, and safety of second-line lurbinectedin monotherapy in small cell lung cancer, Future Oncology, 10.1080/14796694.2025.2499441, 21, 13, (1675-1685), (2025).
- Marcin Dzienis, Ali Mojebi, Sam Keeping, Christopher M. Black, Hilde Giezek, Niroshini Naicker, Chiara Vanetta, Julie E. Park, Keith Chan, Sanjay Merchant, Dandan Zheng, Pembrolizumab with Carboplatin and Paclitaxel Versus Alternative Systemic Treatments Recommended for the First-Line Treatment of Recurrent/Metastatic Head and Neck Cancer: An Indirect Treatment Comparison, Advances in Therapy, 10.1007/s12325-025-03144-4, 42, 6, (2690-2707), (2025).
- Jana Sawyer, Megan Banaszynski, Brian Do, Jesse Cobell, Review of outcomes in a veteran treated with lurbinectedin long-term for extensive-stage small cell lung cancer: A case report, Current Problems in Cancer: Case Reports, 10.1016/j.cpccr.2025.100350, 17, (100350), (2025).
- Manuel Dómine Gómez, Vivek Subbiah, Solange Peters, María Angeles Sala, José Trigo, Luis Paz-Ares, Antonio Nieto Archilla, Javier Gomez Garcia, Cristina Alvarez García, José Antonio López-Vilariño de Ramos, Carmen Kahatt Lopez, Cristian M. Fernandez, Lurbinectedin is an effective alternative to platinum rechallenge and may restore platinum sensitivity in patients with sensitive relapsed small cell lung cancer, Expert Review of Anticancer Therapy, 10.1080/14737140.2024.2438067, 25, 1, (27-40), (2024).
- Joo Sung Shim, Youhyun Kim, Taeho Yuh, Jii Bum Lee, Hye Ryun Kim, Min Hee Hong, Byoung Chul Cho, Sun Min Lim, Real-World Outcomes with Lurbinectedin in Second Line and Beyond for Extensive Stage Small Cell Lung Cancer in Korea, Lung Cancer: Targets and Therapy, 10.2147/LCTT.S485320, Volume 15, (149-159), (2024).
- Firas Badin, Considerations for selecting second-line treatment in patients with progressive small cell lung cancer and the use of Lurbinectedin in this setting, Cancer Treatment and Research Communications, 10.1016/j.ctarc.2024.100803, 39, (100803), (2024).
