Usage and dosage of Lurbinectedin: recommended dose, dose adjustment

Lurbinectedin was jointly developed by JazzPharmaceuticals and PharmaMar. It has a complex chemical structure and is a derivative of ascidin and an inhibitor of RNA polymerase II.

Adult dose for small cell lung cancer

1. Recommended dose

Once every 21 days, 3.2 mg/㎡ each time, intravenously for 60 minutes. until disease progression or unacceptable toxicity occurs.

2. Infusion precautions

(1) This drug can only be started when the absolute neutrophil count (ANC) is at least 1500 cells/mm³ and the platelet count is at least 100,000 cells/mm³.

(2) Consider giving antiemetic prophylaxis before infusion. Corticosteroids (dexamethasone 8 mg intravenously or equivalent); serotonin antagonists (ondansetron 8 mg intravenously or equivalent).

Precautions for taking rupitidine

1. Dosing recommendations

(1) Rubitidine is for intravenous injection only.

(2) Check for particles and discoloration before administration. Do not administer if observed.

(3) Rupitidine can be administered with or without an in-line filter. If an in-line filter is used, it is recommended to use a polyethersulfone in-line filter with a pore size of 0.22 microns.

(4) Consider using a central venous catheter, especially for patients with limited venous access, to reduce the risk of extravasation.

2. Monitoring recommendations

Liver: Check liver function regularly before and during treatment.

Hematology: Monitor blood routine before and during treatment.

Musculoskeletal: Monitor creatine phosphokinase before and periodically during treatment.

Reproduction (for women of childbearing potential): Take a pregnancy test before treatment and confirm the negative result before treatment.

3. Drug compatibility

Lurbinectedin should not be used in combination with other intravenous drugs used simultaneously in the same intravenous infusion line.

Recommended dose adjustment of rubitidine

Recommended dose adjustment of adverse reactions

First dose reduction: 2.6 mg/m² once every 21 days, intravenous injection lasting 60 minutes.

Second dose reduction: 2 mg/m² once every 21 days, intravenous injection lasting 60 minutes.

Permanently discontinue rupitidine in patients who are unable to tolerate the 2 mg/m² dose or who require a delay in dosing for more than 2 weeks.

Rubitidine dose adjustment for specific adverse reactions

1. Neutropenia

Grade 4 or any grade of febrile neutropenia

Suspend treatment until recovery to grade 1 or lower; resume treatment at a reduced dose.

Patients with isolated grade 4 neutropenia (neutrophil count less than 500 cells/cubic millimeter) may receive G-CSF prophylaxis rather than dose reduction.

2. Thrombocytopenia

Grade 3 with bleeding or grade 4

Suspend treatment until the platelet count reaches 100,000 cells/cubic millimeter or higher; resume treatment at a reduced dose.

3. Rhabdomyolysis

Grade 2

Suspend treatment until recovery to grade 1 or lower; resume treatment at the same dose.

Level 3 or higher

Permanently deactivates treatment.

4. Other adverse reactions

Grade 2

Suspend treatment until recovery to grade 1 or lower; resume treatment at the same dose.

Grade 3 or higher

Withhold treatment until recovery to grade 1 or lower; resume treatment at reduced dose or permanently discontinue treatment.

Dose adjustment of rubitidine in special groups

1. Dose adjustment in patients with renal insufficiency

It is not clear yet.

2. Dose adjustment in cases of hepatic insufficiency

(1) Hepatic insufficiency

Mild hepatic insufficiency: that is, total bilirubin [TB] is less than or equal to the upper limit of normal [ULN] and aspartate aminotransferase is greater than the upper limit of normal, or total bilirubin is between 1 and 1.5 times the upper limit of normal and aspartate aminotransferase has any value. It is not recommended to adjust the dose.

Moderate to severe hepatic insufficiency: total bilirubin greater than 1.5 times the upper limit of normal and any value of aspartate aminotransferase, no data available.

(2) Dose adjustment for patients who develop hepatotoxicity during treatment

Grade 2: Suspend treatment until recovery to grade 1 or lower; resume treatment at the same dose.

Grade 3 or higher: Withhold treatment until recovery to grade 1 or lower; resume treatment at reduced dose or permanently discontinue.

Lurbinectedin storage requirements

(1) Please follow applicable special handling and disposal procedures to store Lurbinectedin.

(2) If not used immediately after reconstitution or dilution, this solution can be stored at 2°C to 8°C or at room temperature/normal light for no more than 24 hours.

(3) Store the vial in a refrigerator at 2°C to 8°C.