Anakinra Prophylaxis for Recurrent Severe ICANS Associated With Tarlatamab in Small Cell Lung Cancer: Case Report

Tarlatamab is a bispecific T-cell engager that has demonstrated promising efficacy in treating patients with relapsed small cell lung cancer (SCLC). The incidence of immune-mediated adverse events, including cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), has been reported at relatively low frequencies, with severe events occurring in a minority of patients. Consequently, real-world experience in managing severe ICANS associated with tarlatamab remains limited. We present a case of relapsed SCLC treated with tarlatamab that was complicated by recurrent episodes of severe ICANS. Subsequent administrations incorporated prophylactic anakinra, an interleukin-1 receptor antagonist, to mitigate neurotoxicity, which was well-tolerated and enabled the continuation of therapy, eliciting a significant clinical and radiographic response, including intracranial response. This case warrants further study of interleukin-1 blockade as a potential strategy for ICANS prophylaxis in patients with SCLC who may be at a higher risk for severe ICANS when treated with bispecific antibody therapy.