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Poor Performance Status Associated With Inferior Tarlatamab Outcomes in a Large, Multi-institution Real-World
Adam A Barsouk1, Maxim Yaskolko2, Jonathan H Sussman2
1Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, PA.
Clinical Lung Cancer
|July 25, 2026
Summary
Real-world outcomes for tarlatamab in small cell lung cancer show similar survival for patients with good performance status (PS 0-1) compared to clinical trials. However, poor performance status (PS ≥ 2) is linked to significantly worse survival.
Area of Science:
- Oncology
- Clinical Research
- Pharmacology
Background:
- Tarlatamab is approved for second-line or later extensive-stage small cell lung cancer (ES-SCLC).
- Previous retrospective studies suggested inferior survival with tarlatamab compared to clinical trial data (DeLLphi-304).
- A larger, multi-institutional dataset is needed to clarify real-world tarlatamab outcomes.
Purpose of the Study:
- To evaluate real-world outcomes of tarlatamab in extensive-stage small cell lung cancer.
- To compare real-world outcomes with tarlatamab to those observed in the DeLLphi-304 trial.
- To identify patient characteristics influencing tarlatamab efficacy in a real-world setting.
Main Methods:
- A retrospective analysis of 204 patients treated with tarlatamab from March 2024 to September 2025 using the Flatiron Health Research Database.
- Kaplan-Meier methods were used to estimate median time to treatment discontinuation (mTTD), progression-free survival (mPFS), and overall survival (mOS).
- Log-rank analysis and Cox regression assessed the impact of baseline patient characteristics on outcomes.
Main Results:
- Median PFS was 3.8 months, median TTD was 2.3 months, and median OS was 11.2 months.
- Patients with ECOG Performance Status (PS) ≥ 2 experienced significantly shorter mPFS (2.1 vs. 4.5 months), mTTD (1.6 vs. 2.8 months), and mOS (3.2 vs. 13.4 months) compared to those with ECOG PS 0-1.
- No significant associations were found between patient sex, race, age, or line of therapy and TTD, PFS, or OS.
Conclusions:
- Real-world outcomes (mTTD, mPFS, mOS) for tarlatamab in patients with good performance status (ECOG PS 0-1) align with DeLLphi-304 trial results.
- Inferior real-world outcomes in patients with ECOG PS ≥ 2 may explain discrepancies compared to clinical trial data.
- Line of therapy, race, sex, and age did not significantly impact tarlatamab outcomes in this cohort.