Thoracic Oncology Fellows Forum Is Highlighted by PRO Data and Tarlatamab in SCLC

During an OncLive Fellows Forum on Thoracic Oncology, which took place during the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, fellows from across the country gathered in Chicago, Illinois, to network with each other and faculty members and share their research. The standout presentations from the meeting included a prospective study of patient-reported outcomes (PROs) in hospitalized patients with cancer and a real-world study of tarlatamab-dlle (Imdelltra) in patients with relapsed/refractory small cell lung cancer (SCLC) with untreated brain metastases.

“There was a lot of great [information] presented both in the mentorship meetings that were an adjunct to the Fellows Forum and in the discussion of protocols and abstracts that the fellows presented,” Olivia Fankuchen, MD, MS, a clinical fellow in hematology and oncology at NYU Langone Health in New York, New York, said in an interview with Oncology Fellows. “The way that the mentorship discussions were structured was incredibly helpful for me as somebody who’s a second-year trainee who will be looking for jobs soon. We got all kinds of tailored feedback on everything [including] how to pick disability and life insurance, looking at the right first job setting, and understanding the spectrum of teaching and clinical opportunities between private practice as well as the academic, hybrid, and industry settings.”

Working to Further Understand PROs in Hospitalized Patients

As part of the forum, Noha Soror, MD, a hematology/oncology fellow at the University of Oklahoma College of Medicine in Oklahoma City, presented findings from a prospective study that sought to further understand PROs of hospitalized patients with cancer.1 The study included hospitalized patients with cancer treated at the University of Oklahoma Medical Center from August 2023 to September 2024. Within 2 to 5 days of hospital admission, patients completed surveys assessing physical and psychological symptoms, coping, and resilience. The study authors then applied regression models to identify factors associated with PROs.

“We aimed to investigate PROs in hospitalized patients with cancer,” Soror said in an interview with Oncology Fellows. “Most of the published data we have are in the outpatient setting, but less is known about PROs in the inpatient setting, and that is what drove us to conduct this study. We screened [approximately] 2100 patients and ended up with 300 who were eligible and consented to participate in our study.”

The median age of patients included in the study was 61.4 years (range, 21-92). Most patients were male (57.0%), were White (78.0%), and had incurable disease (73.3%). Cancer types consisted of hematologic malignancies (29.6%), gastrointestinal cancers (20.0%), gynecologic cancers (17.0%), genitourinary cancers (9.7%), thoracic cancers (6.3%), breast cancer (5.0%), head and neck cancer (4.7%), sarcoma (3.0%), skin cancer (1.7%), cancer of unknown primary origin (1.3%), central nervous system tumors (1.3%), and neuroendocrine tumors (0.3%).

Findings from the study, which were also presented in a poster during the ASCO Annual Meeting, revealed that the mean MD Anderson Symptom Inventory (MDASI) interference scores for work, general activity, life enjoyment, walking, mood, and relations with others were 6.45, 5.9, 4.91, 4.79, 4.14, and 2.37, respectively. Additionally, the mean MDASI symptom severity scores for pain, disturbed sleep, drowsiness, dry mouth, lack of appetite, distress, nausea, numbness, sadness, shortness of breath, difficulty remembering, and vomiting were 5.87, 5.77, 5.27, 5.24, 4.57, 3.91, 3.21, 3.18, 3.17, 3.03, 2.92, and 1.66, respectively. Comparatively, the mean baseline MDASI interference and severity scores were 4.77 and 4.2, respectively.

Mean coping scores per the Brief COPE index were evaluated for emotional support (6.66), acceptance (6.55), religion (6.04), activity (5.99), use of instrumental support (5.59), planning (5.46), positive reframing (5.12), self-distraction (4.89), venting (3.83), humor (3.56), self-blame (2.94), denial (2.84), behavioral disengagement (2.46), and substance use (2.14).

“Interestingly, older patients had fewer physical symptoms as measured by MDASI score,” Soror noted. “Female sex was associated with a higher empathy score, as well as positive reframing and distraction as coping mechanisms. A higher comorbidity index was associated with other coping mechanisms, such as substance abuse and behavioral disengagement. Patients with hematologic malignancies had higher [rates of] self-distraction, and we didn’t find any differences in PROs among [patients with] curable vs noncurable cancers.”

Age (P < .01) and female sex (P  < .01) were associated with MDASI severity; older age was also associated with venting (P  = .03), humor (P  < .01), emotional support (P  = .03), and religion (P  = .01) as coping mechanisms. Female sex (P  < .01) and hematologic malignancies (P  = .02) were associated with self-distraction coping. A higher Charlson Comorbidity Index score was associated with substance abuse coping (P < .01) and behavioral disengagement (P  = .03).

“Our findings highlighted the importance of addressing physical and psychological symptoms for patients with cancer admitted to the hospital, and hopefully this research will help us apply targeted intervention for this cohort of patients,” Soror said.

Examining Real-World Outcomes With Tarlatamab in SCLC

Another standout presentation during the Fellows Forum described the real-world use of the bispecific T-cell engager tarlatamab in patients with relapsed/refractory SCLC with untreated brain metastases.2 The study was conducted by a group of fellows from the University of Virginia (UVA) School of Medicine in Charlottesville; their findings were published in Clinical Lung Cancer. The retrospective study examined safety and efficacy outcomes with tarlatamab among all patients who received the agent at UVA between May and October 2024.

“This presentation [described] institutional experience with the real-world application of tarlatamab,” Kelsey Pan, MD, MPH, chief hematology/oncology fellow at the University of Texas MD Anderson Cancer Center in Houston, explained in an interview with Oncology Fellows. “[These] were patients who would have been excluded from the original clinical trial [of the agent]. [The retrospective study authors] enrolled patients with active brain metastases and other exclusion criteria and evaluated the roles of toxicities such as cytokine release syndrome [CRS] and immune effector cell–associated neurotoxicity syndrome [ICANS].”

The study included 21 patients with SCLC and 1 patient with DLL3-positive atypical carcinoid. The median age was 66 years (range, 41-80) and all patients received at least 1 prior line of therapy, including platinum-based chemotherapy and immunotherapy. Most patients were female (59.1%), had extensive-stage SCLC (85.7%), and had liver metastases (63.8%). Notably, 81.8% of patients included in the real-world study would not have met the inclusion and exclusion criteria of the phase 2 DeLLphi-301 trial (NCT05060016), which supported the May 2024 FDA approval of tarlatamab in patients with extensive-stage SCLC who experienced disease progression on or after platinum-based chemotherapy.2,3

At a median follow-up of 6.7 months, any-grade CRS was reported in 72.7% of patients, including grade 1 (40.9%), grade 2 (27.3%), and grade 3 (4.5%) events.2 All instances of CRS occurred during the first cycle of tarlatamab with a median time to onset of 16 hours (IQR, 9.1-18.8) from administration of the drug. However, all CRS-related toxicities were reversible within a median time of 6 hours (IQR, 3.7-28.0).

Any-grade ICANS was reported in 40.9% of patients and in 71.4% (n = 5/7) of patients with untreated brain metastases at the time of tarlatamab initiation. It was assessed as grade 1 in 33.3% (n = 3), grade 2 in 55.6% (n = 5), and grade 4 in 11.1% (n = 1). All ICANS toxicities were deemed to be reversible within a median time of 7 hours (IQR, 4.4-43.2). All events occurred during the first cycle with a median time of 15 hours (IQR 7.7-22.1) from tarlatamab administration.

Any-grade adverse effects (AEs) beyond CRS and ICANS were reported in 90.9% of patients. The most common any-grade AEs included fatigue (72.7%), dysgeusia (63.6%), lymphocytopenia (22.7%), and hypomagnesemia (22.7%).

In terms of efficacy, the objective response rate among all patients who received tarlatamab was 42.9%; all responses were partial. The disease control rate was 71.4%. The median progression-free survival (PFS) was 2.7 months, and the median overall survival was not reached. Notably, data from a subgroup analysis revealed that there was no significant difference in median PFS in terms of time from last immune checkpoint inhibitor therapy, DeLLphi-301 inclusion and exclusion criteria, or ECOG performance status.

“[These data] were interesting because [some of these outcomes] were not evaluated in the original trial,” Pan said. “Now that tarlatamab is approved in the setting of refractory SCLC, it was informative for me to learn how patients who were not the classic trial patients did on this drug.”

References

1. Soror N, Lam AB, Arepalli SSVL, et al. Factors associated with patient-reported outcomes in hospitalized patients with cancer. J Clin Oncol. 2025;43(suppl 16):11116. doi:10.1200/JCO.2025.43.16_suppl.11116
2. Bolte FJ, Dougherty SC, Danos AO, et al. Real-world outcomes of tarlatamab in small cell lung cancer, including patients with untreated brain metastases. Clin Lung Cancer. 2025;26(5):347-353.e1. doi:10.1016/j.cllc.2025.03.006
3. FDA grants accelerated approval to tarlatamab-dlle for extensive stage small cell lung cancer. FDA. May 16, 2024. Accessed July 24, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tarlatamab-dlle-extensive-stage-small-cell-lung-cancer