A multi-institutional perspective on tarlatamab administration and management of CRS/ICANS

Tarlatamab, a bispecific T-cell engager, is the first treatment in many years to significantly improve overall survival in relapsed extensive stage small cell lung cancer (ES-SCLC). However, implementation of this therapy has been challenging due to unique toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) requiring prolonged observation following administration.

We conducted a U.S. based multi-institutional survey through the ONWARD-SCLC consortium, compromised of 15 academic and 1 community centers actively administrating tarlatamab.

We received responses from 9 U.S. academic centers and 1 community-based practice, detailing their standard operating procedures and management of toxicities. While each had unique practices, common strategies included risk stratification, multidisciplinary coordination, communication and education, and well-defined workflows. We highlighted the similarities and differences in the approaches and proposed a list of best practice considerations for tarlatamab administration and toxicity management.

This perspective highlights current best practices and suggests future directions to improve on our current approaches for tarlatamab administration and CRS/ICANS management.