Lurbinectedin – Uses, Dosage, Side Effects, Interaction

Lurbinectedin exerts its chemotherapeutic activity by covalently binding to DNA, resulting in double-strand DNA breaks and subsequent cell death. Lurbinectedin has been associated with myelosuppression, and patients receiving therapy with this agent should be closely monitored for evidence of cytopenias. Prior to beginning therapy, ensure baseline neutrophil counts are >1,500 cells/mm³ and platelet counts are >100,000/mm³. The supplementary use of granulocyte colony-stimulating factor (G-CSF) should be considered if the neutrophil count falls below 500 cells/mm³. Lurbinectedin has also been associated with hepatotoxicity. Monitor liver function tests at baseline and regular intervals throughout therapy, and consider holding, reducing, or permanently discontinuing therapy based on the severity of observed hepatotoxicity.

or

According to PharmaMar,^[rx] lurbinectedin inhibits the active transcription of the encoding genes. This has two consequences. It promotes tumor cell death and normalizes the tumor microenvironment. Active transcription is the process by which there are specific signals where information contained in the DNA sequence is transferred to an RNA molecule. This activity depends on the activity of an enzyme called RNA polymerase II. Lurbinectedin inhibits transcription through a very precise mechanism. Firstly, lurbinectedin binds to specific DNA sequences. It is at these precise spots that slide down the DNA to produce RNA polymerase II that is blocked and degraded by lurbinectedin. Lurbinectedin also has an important role in the tumor microenvironment. The tumor cells act upon macrophages to avoid them from behaving like an activator of the immune system. Macrophages can contribute to tumor growth and progression by promoting tumor cell proliferation and invasion, fostering tumor angiogenesis, and suppressing antitumor immune cells.^[rx][rx] Attracted to oxygen-starved (hypoxic) and necrotic tumor cells they promote chronic inflammation. So, not only that macrophages inhibit the immune system avoiding the destruction of tumor cells, but they also create tumor tissue that allows tumor growth. However, macrophages associated with tumors are cells that are addicted to the transcription process. Lurbinectedin acts specifically on the macrophages associated with tumors in two ways: firstly, by inhibiting the transcription of macrophages that leads to cell death, and secondly, by inhibiting the production of tumor growth factors. In this way, lurbinectedin normalizes the tumor microenvironment.

 Indications

• Lurbinectedin is indicated for the treatment of adult patients with metastatic small-cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy.
• Lurbinectedin is a chemotherapeutic DNA alkylating agent used in the treatment of metastatic small-cell lung cancer.
• Treatment of small cell lung cancer
• Lurbinectedin is an antineoplastic alkylating agent and synthetic derivative of trabectedin that is used to treat refractory, metastatic small-cell lung cancer.
• Metastatic Lung Small Cell Carcinoma

Use in Cancer

Lurbinectedin is approved to treat:

• Small cell lung cancer that is metastatic. It is used in adults whose disease has gotten worse during or after treatment with platinum chemotherapy.

This use is approved under FDA’s Accelerated Approval Program. As a condition of approval, a confirmatory trial(s) must show that lurbinectedin provides a clinical benefit in these patients.

Lurbinectedin is also being studied in the treatment of other types of cancer.

Contraindications

• an increased risk of bleeding
• decreased blood platelets
• low levels of a type of white blood cell called neutrophils
• liver problems
• abnormal liver function tests
• pregnancy
• a patient who is producing milk and breastfeeding
• increased creatine kinase levels

Dosage

Strengths: 4 mg

Small Cell Lung Cancer

• 3.2 mg/m2 IV over 60 minutes every 21 days until disease progression or unacceptable toxicity
• Initiate this drug only if the absolute neutrophil count (ANC) is at least 1500 cells/mm3 and the platelet count is at least 100,000/mm3.
• Consider administering pre-infusion medications for antiemetic prophylaxis: Corticosteroids (e.g., dexamethasone 8 mg IV or equivalent) and serotonin antagonists (e.g., ondansetron 8 mg IV or equivalent). For the treatment of adult patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy.

Dose Adjustments

DOSE REDUCTION:

• First dose reduction: 2.6 mg/m2 IV over 60 minutes every 21 days
• Second dose reduction: 2 mg/m2 IV over 60 minutes every 21 days

DOSE MODIFICATION FOR ADVERSE REACTIONS:
NEUTROPENIA (patients with isolated Grade 4 neutropenia [neutrophil count less than 500 cells/mm3] may receive G-CSF prophylaxis rather than undergo dose reduction):

• Grade 4 or any Grade febrile neutropenia: Withhold therapy until resolved to Grade 1 or less; resume therapy at a reduced dose.

THROMBOCYTOPENIA:

• Grade 3 with bleeding or Grade 4: Withhold therapy until platelet count is 100,000/mm3 or greater; resume therapy at a reduced dose.

HEPATOTOXICITY:

• Grade 2: Withhold therapy until Grade 1 or less; resume therapy at same dose.
• Grade 3 or greater: Withhold therapy until Grade 1 or greater; resume at reduced dose.

Administration advice:

• Advise patients to avoid grapefruit products during therapy with this drug.
• Read the approved patient labeling (Patient Information) before you receive this drug the first time and each subsequent dose.
• Do not become pregnant or breastfeed a child while taking this drug.
• Inform your healthcare providers of all concomitant medications, herbal. and dietary supplements.

Side Effects

The Most Common

• fatigue
• nausea
• vomiting
• constipation
• diarrhea
• loss of appetite
• muscle pain
• headache
• tingling, numbness, and pain in the hands and feet
• chest pain
• shortness of breath
• light-colored bowel movements, yellowing of the skin or eyes, loss of appetite, unusual bleeding or bruising, dark yellow or brown urine, or pain in the upper right part of the stomach
• fever, cough, chills, or other signs of infection
• tiredness or pale skin

More common

• Black, tarry stools
• bleeding gums
• bloody urine
• bone, joint, or muscle pain
• chest pain or tightness
• chills
• dark urine
• difficult or labored breathing
• fever
• the general feeling of discomfort or illness
• hoarseness
• loss of appetite
• lower back or side pain
• nausea
• painful or difficult urination
• pale skin
• pale stools
• pinpoint red spots on the skin
• sneezing
• sore throat
• stomach pain or tenderness
• thickening of bronchial secretions
• trouble breathing
• ulcers, sores, or white spots in the mouth
• unusual bleeding or bruising
• unusual tiredness or weakness
• vomiting
• yellow eyes or skin

Rare

• Swelling of the feet or lower legs
• Muscle cramps, spasms, or stiffness
• pain, discomfort, itching, redness, or swelling at the injection site
• Burning, numbness, tingling, or painful sensations
• change in or loss of taste
• constipation
• diarrhea
• headache
• unsteadiness or awkwardness

Drug Interactions

DRUG	INTERACTION
Abametapir	The serum concentration of Lurbinectedin can be increased when it is combined with Abametapir.
Amiodarone	The serum concentration of Lurbinectedin can be increased when it is combined with Amiodarone.
Amprenavir	The serum concentration of Lurbinectedin can be increased when it is combined with Amprenavir.
Apalutamide	The serum concentration of Lurbinectedin can be decreased when it is combined with Apalutamide.
Aprepitant	The serum concentration of Lurbinectedin can be increased when it is combined with Aprepitant.
Articaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Articaine.
Atazanavir	The serum concentration of Lurbinectedin can be increased when it is combined with Atazanavir.
Avanafil	The serum concentration of Avanafil can be increased when it is combined with Lurbinectedin.
Benzocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Benzocaine.
Benzyl alcohol	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Benzyl alcohol.
Berotralstat	The serum concentration of Lurbinectedin can be increased when it is combined with Berotralstat.
Bexarotene	The serum concentration of Lurbinectedin can be decreased when it is combined with Bexarotene.
Boceprevir	The serum concentration of Lurbinectedin can be increased when it is combined with Boceprevir.
Bosentan	The serum concentration of Lurbinectedin can be decreased when it is combined with Bosentan.
Bupivacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Bupivacaine.
Butacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Butacaine.
Butamben	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Butamben.
Capsaicin	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Capsaicin.
Carbamazepine	The serum concentration of Lurbinectedin can be decreased when it is combined with Carbamazepine.
Cenobamate	The serum concentration of Lurbinectedin can be decreased when it is combined with Cenobamate.
Chloroprocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Chloroprocaine.
Cinchocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Cinchocaine.
Ciprofloxacin	The serum concentration of Lurbinectedin can be increased when it is combined with Ciprofloxacin.
Clarithromycin	The serum concentration of Lurbinectedin can be increased when it is combined with Clarithromycin.
Clozapine	The serum concentration of Lurbinectedin can be increased when it is combined with Clozapine.
Cobicistat	The serum concentration of Lurbinectedin can be increased when it is combined with Cobicistat.
Cocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Cocaine.
Conivaptan	The serum concentration of Lurbinectedin can be increased when it is combined with Conivaptan.
Crizotinib	The serum concentration of Lurbinectedin can be increased when it is combined with Crizotinib.
Curcumin	The serum concentration of Lurbinectedin can be increased when it is combined with Curcumin.
Cyclosporine	The serum concentration of Lurbinectedin can be increased when it is combined with Cyclosporine.
Dabrafenib	The serum concentration of Lurbinectedin can be decreased when it is combined with Dabrafenib.
Danazol	The serum concentration of Lurbinectedin can be increased when it is combined with Danazol.
Darbepoetin alfa	The risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Lurbinectedin.
Darunavir	The serum concentration of Lurbinectedin can be increased when it is combined with Darunavir.
Delavirdine	The serum concentration of Lurbinectedin can be increased when it is combined with Delavirdine.
Desvenlafaxine	The serum concentration of Lurbinectedin can be increased when it is combined with Desvenlafaxine.
Dexamethasone	The serum concentration of Lurbinectedin can be decreased when it is combined with Dexamethasone.
Dexamethasone	The serum concentration of Lurbinectedin can be decreased when it is combined with Dexamethasone acetate.
Diltiazem	The serum concentration of Lurbinectedin can be increased when it is combined with Diltiazem.
Diphenhydramine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Diphenhydramine.
Dronedarone	The serum concentration of Lurbinectedin can be increased when it is combined with Dronedarone.
Dyclonine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Dyclonine.
Echinacea	The serum concentration of Lurbinectedin can be decreased when it is combined with Echinacea.
Econazole	The serum concentration of Lurbinectedin can be increased when it is combined with Econazole.
Efavirenz	The serum concentration of Lurbinectedin can be decreased when it is combined with Efavirenz.
Elvitegravir	The serum concentration of Lurbinectedin can be increased when it is combined with Elvitegravir.
Enzalutamide	The serum concentration of Lurbinectedin can be decreased when it is combined with Enzalutamide.
Ergotamine	The serum concentration of Lurbinectedin can be increased when it is combined with Ergotamine.
Erythromycin	The serum concentration of Lurbinectedin can be increased when it is combined with Erythromycin.
Erythropoietin	The risk or severity of Thrombosis can be increased when Erythropoietin is combined with Lurbinectedin.
Ethyl chloride	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Ethyl chloride.
Etidocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Etidocaine.
Etravirine	The serum concentration of Lurbinectedin can be decreased when it is combined with Etravirine.
Fluconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Fluconazole.
Fluvoxamine	The serum concentration of Lurbinectedin can be increased when it is combined with Fluvoxamine.
Fosnetupitant	The serum concentration of Lurbinectedin can be increased when it is combined with Fosnetupitant.
Fosphenytoin	The serum concentration of Lurbinectedin can be decreased when it is combined with Fosphenytoin.
Fusidic acid	The serum concentration of Lurbinectedin can be increased when it is combined with Fusidic acid.
Haloperidol	The serum concentration of Lurbinectedin can be increased when it is combined with Haloperidol.
Indinavir	The serum concentration of Lurbinectedin can be increased when it is combined with Indinavir.
Isavuconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Isavuconazole.
Isavuconazonium	The serum concentration of Lurbinectedin can be increased when it is combined with Isavuconazonium.
Isoniazid	The serum concentration of Lurbinectedin can be increased when it is combined with Isoniazid.
Isradipine	The serum concentration of Lurbinectedin can be increased when it is combined with Isradipine.
Itraconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Itraconazole.
Ivosidenib	The metabolism of Lurbinectedin can be increased when combined with Ivosidenib.
Ketoconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Ketoconazole.
Levobupivacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Levobupivacaine.
Levoketoconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Levoketoconazole.
Lidocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Lidocaine.
Linagliptin	The serum concentration of Lurbinectedin can be increased when it is combined with Linagliptin.
Lonafarnib	The serum concentration of Lurbinectedin can be increased when it is combined with Lonafarnib.
Lopinavir	The serum concentration of Lurbinectedin can be increased when it is combined with Lopinavir.
Lovastatin	The serum concentration of Lurbinectedin can be increased when it is combined with Lovastatin.
Luliconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Luliconazole.
Lumacaftor	The serum concentration of Lurbinectedin can be decreased when it is combined with Lumacaftor.
Mavacamten	The serum concentration of Lurbinectedin can be decreased when it is combined with Mavacamten.
Meloxicam	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Meloxicam.
Mepivacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Mepivacaine.
Methimazole	The serum concentration of Lurbinectedin can be increased when it is combined with Methimazole.
Methoxy poly	The risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Lurbinectedin.
metreleptin	The metabolism of Lurbinectedin can be increased when combined with metreleptin.
Miconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Miconazole.
Midostaurin	The serum concentration of Lurbinectedin can be decreased when it is combined with Midostaurin.
Milnacipran	The serum concentration of Lurbinectedin can be increased when it is combined with Milnacipran.
Mitotane	The serum concentration of Lurbinectedin can be decreased when it is combined with Mitotane.
Modafinil	The serum concentration of Lurbinectedin can be decreased when it is combined with Modafinil.
Nafcillin	The serum concentration of Lurbinectedin can be decreased when it is combined with Nafcillin.
Nefazodone	The serum concentration of Lurbinectedin can be increased when it is combined with Nefazodone.
Nelfinavir	The serum concentration of Lurbinectedin can be increased when it is combined with Nelfinavir.
Netupitant	The serum concentration of Lurbinectedin can be increased when it is combined with Netupitant.
Nicardipine	The serum concentration of Lurbinectedin can be increased when it is combined with Nicardipine.
Nilotinib	The serum concentration of Lurbinectedin can be increased when it is combined with Nilotinib.
Nilvadipine	The serum concentration of Lurbinectedin can be increased when it is combined with Nilvadipine.
Oxetacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Oxetacaine.
Oxybuprocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Oxybuprocaine.
Peginesatide	The risk or severity of Thrombosis can be increased when Peginesatide is combined with Lurbinectedin.
Pentobarbital	The serum concentration of Lurbinectedin can be decreased when it is combined with Pentobarbital.
Phenobarbital	The serum concentration of Lurbinectedin can be decreased when it is combined with Phenobarbital.

Phenol	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Phenol.
Phenytoin	The serum concentration of Lurbinectedin can be decreased when it is combined with Phenytoin.
Pitolisant	The serum concentration of Lurbinectedin can be decreased when it is combined with Pitolisant.
Posaconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Posaconazole.
Pramocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Pramocaine.
Prilocaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Prilocaine.
Primaquine	The serum concentration of Lurbinectedin can be increased when it is combined with Primaquine.
Primidone	The serum concentration of Lurbinectedin can be decreased when it is combined with Primidone.
Procaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Procaine.
Proparacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Proparacaine.
Propoxycaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Propoxycaine.
Ribociclib	The serum concentration of Lurbinectedin can be increased when it is combined with Ribociclib.
Rifampicin	The serum concentration of Lurbinectedin can be decreased when it is combined with Rifampicin.
Rifamycin	The serum concentration of Lurbinectedin can be decreased when it is combined with Rifamycin.
Rifapentine	The serum concentration of Lurbinectedin can be decreased when it is combined with Rifapentine.
Rimexolone	The serum concentration of Lurbinectedin can be decreased when it is combined with Rimexolone.
Ritonavir	The serum concentration of Lurbinectedin can be increased when it is combined with Ritonavir.
Ropivacaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Ropivacaine.
Saquinavir	The serum concentration of Lurbinectedin can be increased when it is combined with Saquinavir.
Satralizumab	The serum concentration of Lurbinectedin can be decreased when it is combined with Satralizumab.
Simeprevir	The serum concentration of Lurbinectedin can be increased when it is combined with Simeprevir.
Somatrogon	The metabolism of Lurbinectedin can be increased when combined with Somatrogon.
Sotorasib	The serum concentration of Lurbinectedin can be decreased when it is combined with Sotorasib.
St. John’s Wort	The serum concentration of Lurbinectedin can be decreased when it is combined with St. John’s Wort.
Stiripentol	The serum concentration of Lurbinectedin can be increased when it is combined with Stiripentol.
Telaprevir	The serum concentration of Lurbinectedin can be increased when it is combined with Telaprevir.
Telithromycin	The serum concentration of Lurbinectedin can be increased when it is combined with Telithromycin.
Telotristat ethyl	The serum concentration of Lurbinectedin can be decreased when it is combined with Telotristat ethyl.
Terfenadine	The serum concentration of Lurbinectedin can be increased when it is combined with Terfenadine.
Tetracaine	The risk or severity of methemoglobinemia can be increased when Lurbinectedin is combined with Tetracaine.
Tioconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Tioconazole.
Tipranavir	The serum concentration of Lurbinectedin can be increased when it is combined with Tipranavir.
Troleandomycin	The serum concentration of Lurbinectedin can be increased when it is combined with Troleandomycin.
Tucatinib	The metabolism of Tucatinib can be decreased when combined with Lurbinectedin.
Venetoclax	The serum concentration of Lurbinectedin can be increased when it is combined with Venetoclax.
Verapamil	The serum concentration of Lurbinectedin can be increased when it is combined with Verapamil.
Viloxazine	The metabolism of Lurbinectedin can be decreased when combined with Viloxazine.
Voriconazole	The serum concentration of Lurbinectedin can be increased when it is combined with Voriconazole.
Zimelidine	The serum concentration of Lurbinectedin can be increased when it is combined with Zimelidine.
Ziprasidone	The serum concentration of Lurbinectedin can be increased when it is combined with Ziprasidone.

Pregnancy and Lactation

 

Pregnancy

Based on animal data and its mechanism of action, ZEPZELCA can cause fetal harm when administered to a pregnant woman. There are no
available data to inform the risk of ZEPZELCA use in pregnant women. Intravenous administration of a single lurbinectedin dose (approximately 0.2 times the 3.2 mg/m2 clinical dose) to pregnant rats during the period of organogenesis caused embryo lethality. Advise pregnant women of the potential risk to a fetus.
The estimated background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth
defects and miscarriage in clinically recognized pregnancies is 2 to 4% and 15 to 20%, respectively.

Lactation

There are no data on the presence of lurbinectedin in human milk or its effects on the breastfed child or on milk production. Because of the potential for serious adverse reactions from ZEPZELCA in breastfed children, advise women not to breastfeed during treatment with
ZEPZELCA and for 2 weeks after the final dose.

Why is this medication prescribed?

Lurbinectedin injection is used to treat small cell lung cancer (SCLC) that has spread to other parts of the body and did not improve during or after treatment with platinum chemotherapy. Lurbinectedin injection is in a class of medications called alkylating agents. It works by slowing or stopping the growth of cancer cells in your body.

How should this medicine be used?

Lurbinectedin injection comes as powder to be mixed with liquid to be injected intravenously (into a vein) over 60 minutes by a doctor or nurse in a hospital or medical facility. It is usually given once every 21 days. Your doctor will decide how often you are to receive lurbinectedin based on your body’s response to this medication.

Your doctor may need to temporarily or permanently stop your treatment or decrease your dose if you experience certain side effects. It is important for you to tell your doctor how you are feeling during your treatment with lurbinectedin injection. Your doctor will give you medication to prevent nausea and vomiting before you receive each dose of lurbinectedin.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before receiving lurbinectedin injection,

• tell your doctor and pharmacist if you are allergic to lurbinectedin, any other medications, or any of the ingredients in lurbinectedin injection. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, or nutritional supplements you are taking or plan to take. Be sure to mention any of the following: antifungal medications such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), ketoconazole (Nizoral), and voriconazole (Vfend); clarithromycin (Biaxin, Prevpac); diltiazem (Cardizem, Dilacor, Tiazac, others); erythromycin (E-mycin, Ery-Tab, others); certain HIV medications such as efavirenz (Sustiva), indinavir (Crixivan), nelfinavir (Viracept), nevirapine (Viramune), ritonavir (Norvir, in Kaletra), and saquinavir (Invirase); nefazodone; pioglitazone (Actos, in Oseni); rifabutin (Mycobutin); prednisone; rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); certain medications for seizures such as carbamazepine (Carbatrol, Epitol, Tegretol, others), phenobarbital, and phenytoin (Dilantin, Phenytek); and verapamil (Calan, Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may interact with lurbinectedin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you more carefully for side effects.
• tell your doctor what herbal products you are taking, especially St. John’s wort.
• tell your doctor if you have or have ever had liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or if you plan to father a child. You or your partner should not become pregnant while you are receiving lurbinectedin injection. Your doctor may perform a pregnancy test to be sure that you are not pregnant before you receive lurbinectedin injection. If you are female, you should use birth control during your treatment and for 6 months after your final dose. If you are male, you and your female partner should use birth control during your treatment and for 4 months after your final dose. If you or your partner become pregnant while receiving lurbinectedin injection, call your doctor. Lurbinectedin injection may harm the fetus.
• tell your doctor if you are breastfeeding. You should not breastfeed while you are receiving lurbinectedin injection and for at least 2 weeks after your final dose.

References