2025 Targeted Therapies of Lung Cancer (TTLC) - Posters-PP01.42 A Single-Center Experience Initiating Tarlatamab Treatment for Relapsed Extensive-Stage Small Cell Lung Cancer: Navigating Cytokine Release Syndrome

PP01.42 A Single-Center Experience Initiating Tarlatamab Treatment for Relapsed Extensive-Stage Small Cell Lung Cancer: Navigating Cytokine Release Syndrome

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The document details an experience with tarlatamab, an FDA-approved bispecific T-cell engager immunotherapy, in treating a 52-year-old male patient with relapsed extensive-stage small cell lung cancer (SCLC). The patient, having previously progressed after carboplatin, etoposide, and atezolizumab treatment, was administered tarlatamab following a step-up dosing regimen. Tarlatamab targets the delta-like ligand 3 and CD3 and comes with a boxed warning for potential serious adverse effects like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).<br /><br />The initial phase involved administering tarlatamab intravenously in an inpatient setting to monitor for adverse events, which included extra intravenous (IV) fluids and premedication with dexamethasone to curb CRS risks. Subsequent doses were given on an outpatient basis, provided the patient's stability was confirmed.<br /><br />The patient showed a favorable response, with the anterior chest wall mass shrinking significantly after treatment. PET scans reflected a noticeable reduction in metabolic activity and tumor size. Despite experiencing grade 2 CRS after the third dose, characterized by hypotension and mild dizziness, management involved hospitalization and supportive care, preventing further episodes. No ICANS symptoms were noted.<br /><br />The team's approach emphasized the importance of inpatient monitoring during initial doses, home vital sign education, and PRN management strategies for CRS. Safety measures included the use of midodrine for ongoing hypotension post-treatment and fall prevention at home. Their experience underscores the potential for tarlatamab as a viable option for relapsed SCLC with careful management of its adverse effects, ensuring patient safety through structured dosing regimens and proactive supportive care.

Asset Subtitle

Niket Shah

Keywords

tarlatamab

SCLC

immunotherapy

cytokine release syndrome

ICANS

bispecific T-cell engager

delta-like ligand 3

FDA-approved

relapsed extensive-stage

supportive care