Integrating Novel Therapies in Relapsed ES-SCLC

Tarlatamab has established itself as the standard of care for second-line extensive stage small cell lung cancer (ES-SCLC) based on randomized trial data, yet implementation challenges persist across health care systems. Dr Sands emphasizes that centers not yet offering tarlatamab must develop capabilities to provide this practice-changing therapy, as it represents the evidence-based standard for relapsed disease. The primary implementation barrier involves the FDA-recommended 22- to 24-hour observation period for the first 2 doses, requiring inpatient monitoring capabilities and coordination between oncology and hospital systems.

Clinical experience suggests that tarlatamab can benefit patients beyond the original trial population, including those with poor performance status, high disease burden, elevated liver function tests, and significant comorbidities. The panel notes that tarlatamab often produces rapid responses without the performance status decline typically associated with chemotherapy, making it suitable for patients who might not tolerate traditional cytotoxic therapy. However, initial tumor flare and increased pain require experienced management, emphasizing the learning curve associated with implementing T-cell engager therapy.

The experts stress that cytokine release syndrome (CRS) occurs almost exclusively during the first treatment cycle, allowing for collaborative care models where academic centers initiate therapy and community practices continue treatment after the high-risk period. This approach addresses capacity constraints while ensuring patient access to this transformative therapy. Patient education becomes crucial, including wallet cards for emergency department visits and coordination with local hospitals that may not be familiar with T-cell engager management, ensuring appropriate recognition and treatment of potential complications across health care settings.