This is a single-arm, phase I/II trial to determine the Maximum Tolerated Dose (MTD),
Recommended Phase II Dose (RP2D), and the safety and efficacy of the combination of
nivolumab-ipilimumab plus lurbinectedin in patients with relapsed/recurrent small cell lung
cancer after progression with first-line, platinum-based chemotherapy
- Measurable disease based on RECIST v1.1
- Performance status of 0-1 on the Eastern Cooperative Oncology Group (ECOG) performance
- Adequate organ function as defined per protocol
- Women of child bearing potential (WOCBP) must have a negative urine or serum pregnancy
test within 72 hours from receiving first dose of study medication. If the urine test
is positive or cannot be confirmed as negative, a serum pregnancy test will be
- WOCBP should agree to use 2 methods of birth control or abstain from heterosexual
activity for the course of the study through 5 months after the last dose of study
medication, or should be surgically sterile. Note: A woman is considered to be of
"reproductive potential" (WOCBP) if she has had menses at any time in the preceding 12
consecutive months. In addition to routine contraceptive methods, "effective
contraception" also includes heterosexual celibacy and surgery intended to prevent
pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy,
bilateral oophorectomy or bilateral tubal ligation. However, if at any point a
previously celibate patient chooses to become heterosexually active during the time
period for use of contraceptive measures, she is responsible for beginning
- Male participants should agree to use an adequate method of contraception starting
with the first dose of study therapy through 7 months after the last dose of study
Note: In addition to routine contraceptive methods, "effective contraception" also includes
heterosexual celibacy and surgery intended to prevent pregnancy (vasectomy). However, if at
any point a previously celibate patient chooses to become heterosexually active during the
time period for use of contraceptive measures, he is responsible for beginning
Individuals meeting any of the following criteria will be excluded from participation in
- Is currently participating in a study of an investigational agent or device and
received or used the investigational agent or device within 4 weeks of the first dose
- Has a diagnosis of immunodeficiency or is receiving systemic steroid or any other form
of immunosuppressive therapy within 7 days prior to the first dose of treatment. Note:
Systemic steroid doses of ≤ 10 mg of prednisone daily or its equivalent are allowed in
patients receiving physiologic replacement steroid doses
- Has a known history of active Bacillus Tuberculosis (TB)
- Hypersensitivity to Lurbinectedin, Ipilimumab and/or nivolumab or any of its
- Has had a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study
Day 1 or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events
due to agents administered more than 4 weeks earlier.
- Has had targeted small molecule therapy, or standard fractionated radiotherapy within
2 weeks, chemotherapy within 3 weeks and stereotactic radiotherapy within 1 week prior
to study Day 1 or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse
events due to a previously administered agent. Note:: Participants with ≤ Grade 2
neuropathy are an exception to this criterion and may qualify for the study. If
participant received major surgery, they must have recovered adequately from the
toxicity and/or complications from the intervention prior to starting therapy.
- Has a known additional malignancy that is progressing or requires active treatment.
Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the
skin that has undergone potentially curative therapy or in situ cervical cancer. Other
malignancies that remain without evidence of disease or recurrence, 2 years or more
after curative therapy are also considered part of this exception.
- Has known active central nervous system (CNS) metastases and/or carcinomatous
meningitis. Participants with previously treated brain metastases may participate
provided they are stable (without evidence of progression by imaging for at least 2
weeks prior to the first dose of trial treatment and any neurologic symptoms have
returned to baseline), have no evidence of new or enlarging brain metastases, and are
not using steroids for at least 7days prior to trial treatment. This exception does
not include carcinomatous meningitis which is excluded regardless of clinical
- Has any of the following concomitant diseases/conditions:
1. History or presence of unstable angina, myocardial infarction, congestive heart
failure, or clinically significant valvular heart disease within last year.
2. Symptomatic arrhythmia or any uncontrolled arrhythmia requiring ongoing
3. History of idiopathic, pulmonary fibrosis, organizing pneumonia, drug-induced
pneumonitis, idiopathic pneumonitis or evidence of active pneumonitis on
screening chest CT-scan. History of radiation pneumonitis in radiation field
(fibrosis) is permitted, as long as it is asymptomatic and no steroids are
4. Myopathy or any clinical situation that causes significant and persistent
elevation of CPK (>2.5 x upper limit of normal (ULN) in two different
determinations performed one week apart).
- Any diagnosis of autoimmune disease (confirmed by medical records or appropriate
laboratory testing) is not allowed.
- Has an active infection requiring systemic therapy.
- Has a history or current evidence of any condition, therapy, or laboratory abnormality
that might confound the results of the trial, interfere with the patient's
participation for the full duration of the trial, or is not in the best interest of
the patient to participate, in the opinion of the treating investigator.
- Has known psychiatric or substance abuse disorders that would interfere with
cooperation with the requirements of the trial.
- Is pregnant or breastfeeding, or expecting to conceive or father children within the
projected duration of the trial, starting with the pre-screening or screening visit
through 120 days after the last dose of trial treatment.
- Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies), active
Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is
- Has received a live vaccine within 30 days of start of study therapy. Note: Seasonal
influenza vaccines for injection are generally inactivated flu vaccines and are
allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated
vaccines, and are not allowed.
- Patients who had a prior Grade ≥3 immune-related adverse event (e.g. pneumonitis,
hepatitis, colitis, endocrinopathy) with prior immunotherapy (e.g. cancer vaccine,
- Patients must not be pregnant or nursing due to risk of fetal or nursing infant harm.
WOCBP must have agreed to use an effective contraceptive method.
- Participants with interstitial lung disease that is symptomatic or may interfere with
the detection or management of suspected drug-related pulmonary toxicity.
- Participants who are compulsorily detained for treatment of either a psychiatric or
physical (e.g., infectious disease) illness