Inclusion Criteria:

1. Cytologically and/or histologically confirmed small-cell lung cancer with extensive
stage disease.

2. Measurable or evaluable disease per RECIST criteria version 1.1.

3. Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0-1.

4. Left ventricular ejection fraction (LVEF) ≥50% by echocardiogram (ECHO) or multiple
gated acquisition scan (MUGA).

5. QTc interval of ≤450 msec. on ECG.

6. Adequate organ function, including the following:

- ANC ≥1500 cells/micro liter

- Platelet count ≥100,000 cells/micro liter

- Hemoglobin ≥9 g/dL

- Total bilirubin ≤1.5 x ULN; AST/ALT ≤2.5 x ULN, (except if due to hepatic
metastases, then ≤5 x ULN)

- Serum creatinine ≤1.5 x ULN

7. Patients must be able to receive growth factors (G-CSF).

8. Women of childbearing potential must have a negative serum or urine pregnancy test
performed ≤ 7 days prior to start of treatment. Women of childbearing potential or
men with partners of childbearing potential must use effective birth control measures
during treatment. If a woman becomes pregnant or suspects she is pregnant while
participating in this study, she must agree to inform her treating physician
immediately.

9. Patients ≥18 years of age.

10. Patients must be accessible for treatment and follow-up.

11. Patients must be able to understand the investigational nature of this study and give
written informed consent prior to study entry.

Exclusion Criteria:

1. Previous treatment for limited-stage SCLC.

2. Previous chemotherapy or radiation therapy for SCLC (unless radiation was
administered for brain metastases).

3. Active brain metastases. Patients with treated brain metastases are eligible, if (1)
radiation therapy was completed ≥ 21 days prior to first dose of amrubicin; (2)
follow-up scan shows no disease progression; an absence of neurologic symptoms and
(3) patient does not require steroids.

4. Mixed small cell/non-small cell tumors or other neuroendocrine lung cancers.

5. Women who are pregnant or breastfeeding.

6. Suspected, diffuse idiopathic interstitial lung disease or pulmonary fibrosis.

7. Patients with New York Heart Association (NYHA) class II or greater congestive heart
failure (CHF).

8. Any of the following ≤6 months prior to starting study treatment:

- myocardial infarction;

- severe unstable angina;

- ongoing cardiac dysrhythmia.

9. Family history of idiopathic cardiomyopathy or uncontrolled heart arrhythmia.

10. Treatment for other invasive cancers during the previous 5 years, or the presence of
any active invasive cancer of any type (with the exception of non-melanoma skin
cancers).

11. Uncontrolled hypertension (i.e., blood pressure >150/90 mmHg that cannot be
controlled with standard anti-hypertensive agents).

12. Major surgical procedure or significant traumatic injury ≤ 28 days of study
initiation.

13. History of seropositive HIV or patients who are receiving immunosuppressive
medications that would in the opinion of the investigator increase the risk of the
serious neutropenic complications.

14. Concurrent severe, intercurrent illness including, but not limited to, ongoing or
active infection, or psychiatric illness/social situations that would limit
compliance with study requirements.

15. Any condition that would prevent patient comprehension of the nature of, and risk
associated with, the study.

16. Use of any non-approved or investigational agent ≤30 days prior to administration of
the first dose of study drug. Patients may not receive any other investigational or
anti-cancer treatments while participating in this study.