Jazz Pharmaceuticals and Roche's combination of Zepzelca (lurbinectedin) and Tecentriq (atezolizumab) has demonstrated a statistically significant improvement in overall survival (OS) and progression-free survival (PFS) in patients with extensive-stage small cell lung cancer (ES-SCLC). The findings come from the Phase III IMforte trial and support a potential new first-line maintenance therapy option for this aggressive disease.
The IMforte trial is a Phase III, open-label, multi-center study that randomized patients with ES-SCLC (1:1) to receive either 1200 mg of intravenous atezolizumab every three weeks plus 3.2 mg/m2 of intravenous lurbinectedin every three weeks, or 1200 mg of intravenous atezolizumab alone every three weeks. All patients had previously undergone induction therapy with four 21-day cycles of atezolizumab (1200 mg intravenously) plus carboplatin and etoposide. The primary endpoints were PFS and OS, assessed by an independent review facility.
Key Findings from the IMforte Trial
The trial's results indicated a statistically significant improvement in both OS and PFS for the combination of lurbinectedin and atezolizumab compared to atezolizumab alone. The safety profile of the combination was consistent with the known profiles of each drug, with no new safety signals identified.
Luis Paz-Ares, MD, PhD, head of medical oncology at the Hospital Universitario 12 de Octubre in Madrid, Spain, and lead investigator of the IMforte trial, noted that the results demonstrate the efficacy of lurbinectedin, the most widely used agent in second-line SCLC in the United States, in combination with standard-of-care atezolizumab for patients in first-line maintenance treatment.
Regulatory and Clinical Implications
Jazz Pharmaceuticals plans to submit a supplemental New Drug Application (sNDA) to the FDA in the first half of 2025, seeking approval for the Zepzelca/Tecentriq combination as a first-line maintenance treatment for ES-SCLC. This regulatory submission could potentially expand the treatment options available for patients with this aggressive form of lung cancer.
Rob Iannone, MD, MSCE, executive vice president, global head of research and development, and chief medical officer at Jazz Pharmaceuticals, stated that the results are highly encouraging and demonstrate the potential of the regimen to delay disease progression and extend survival for patients with ES-SCLC.
Zepzelca's Background and Previous Approvals
Zepzelca received accelerated approval from the FDA in June 2020 for the treatment of adult patients with metastatic SCLC who have progressed on or after platinum-based chemotherapy. The IMforte trial serves as one of two studies intended to confirm Zepzelca's benefit in SCLC, following a previously failed confirmatory trial (ATLANTIS) due to dosing differences.
Current Treatment Landscape for ES-SCLC
Approximately 30,000 new cases of SCLC are reported annually in the United States, with a majority diagnosed at the extensive stage. ES-SCLC is characterized by its aggressive nature and poor prognosis, highlighting the need for improved treatment strategies. The current standard of care involves chemotherapy, but relapse is common, underscoring the importance of maintenance therapies that can prolong survival and delay disease progression.
