Considering Dosing and AE Management Strategies With Tarlatamab in SCLC

In the second edition of a special podcast series, CancerNetwork® spoke with Daniel Morgensztern, MD; Mary Ellen Flanagan, NP; and Janelle Mann, PharmD, BCOP, about the best practices for incorporating recently approved bispecific antibodies into cancer care. This discussion focused on clinical trial results, administration protocols, and adverse effect (AE) management strategies related to the use of tarlatamab-dlle (Imdelltra) for patients with small cell lung cancer (SCLC).

Morgensztern is a professor of Medicine and the clinical director of Thoracic Oncology in the Division of Oncology at Washington University School of Medicine in St. Louis. Flanagan is a nurse practitioner in the Division of Thoracic Oncology at Washington University. Mann is a clinical oncology pharmacist at Siteman Cancer Center of Washington University School of Medicine and manager of Clinical Pharmacy Services at Barnes-Jewish Hospital.

The conversation opened with Morgensztern highlighting tarlatamab’s mechanism of action as an agent that targets DLL3. He then reviewed prior efficacy data that the therapy demonstrated in the phase 1 DeLLphi-300 trial (NCT03319940) and the phase 2 DeLLphi-301 trial (NCT05060016). Of note, the FDA approved tarlatamab as the first available T-cell engager immunotherapy for patients with extensive-stage SCLC who have progressed on prior platinum-containing chemotherapy in May 2024 based on data from the DeLLphi-301 trial.

Additionally, Flanagan detailed strategies for monitoring and mitigating the most common AEs associated with tarlatamab in this patient population, which include cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Mann then outlined considerations for properly dosing and administering the agent, highlighting factors that clinicians should keep in mind when continuing treatment in an inpatient or outpatient setting.

The group also spoke about clinical decision-making related to patients who have brain metastases, which included processes for adjusting the dose of tarlatamab and sequencing the bispecific agent with radiotherapy.

Reference

FDA grants accelerated approval to tarlatamab-dlle for extensive stage small cell lung cancer. News release. FDA. May 16, 2024. Accessed March 14, 2025. https://tinyurl.com/48k34rw5