Age-based differences in outcomes among small cell lung cancer patients treated with tarlatamab.

Abstract

8069 Background: Tarlatamab has durable antitumor activity in patients with previously treated Small Cell Lung Cancer (SCLC). A rising fraction of SCLC diagnoses is now observed in older patient groups. To assess real-world outcomes, we analyzed a large, multi-institutional database evaluating age-related differences in survival, treatment patterns, and immune toxicities, including Cytokine Release Syndrome (CRS) and Immune Effector Cell-associated Neurotoxicity Syndrome (ICANS), to clarify factors affecting response and tolerability. Methods: A retrospective cohort study was conducted using de-identified data from the TriNetX Research Network. At the time of data analysis, it included 154,537,377 patients across 113 healthcare organizations. We identified adults aged 18 years or older with lung cancer treated with Tarlatamab. Kaplan-Meier analysis assessed overall survival. Statistical comparisons of survival rates between groups were performed using the log-rank test. Propensity matching was used to adjust for age, comorbidities, and lines of treatment. Results: A total of 616 patients were identified in the TriNetX cohort, with a mean age of 65.8 ± 9.89 years, and 51.9% were female. Age distribution was as follows: 124 patients (20.13%) were younger than 60 years, 271 (43.99%) were 60–70 years, and 221 (35.88%) were older than 70 years. Brain metastases were present in 53 patients (8.60%) in the <60 group, 116 (18.83%) in the 60–70 group, and 90 (14.61%) in the >70 group. Median overall survival of the entire cohort was 13.32 months; it was not reached in the <60 group, 13.32 months in the 60–70 group, and 12.72 months in the >70 group, with no significant differences across age groups or brain metastasis status. In the propensity score–matched cohorts, survival did not differ significantly between <60 and >70 age groups (HR 0.80 (95% CI 0.34–1.22; p=0.39)), and a similar lack of difference was observed between 60–70 and >70 age groups (HR 0.72 (95% CI 0.48–1.07; p=0.10)). In the overall population, 57 patients (9.25%) experienced ICANS and 67 (10.88%) developed CRS. By age group, ICANS and CRS occurred in 16 (2.60%) and 17 (2.76%) patients <60, 23 (3.73%) and 29 (4.71%) patients 60–70, and 18 (2.92%) and 21 (3.40%) patients >70, respectively. Overall, 91 patients (14.77%) required tocilizumab and 23 (3.73%) required vasopressors, with no significant differences across the three age groups. Conclusions: This study offers an extensive evaluation of age-related outcomes with Tarlatamab. Neither age nor brain metastases significantly influenced overall survival, indicating preserved efficacy in older adults. ICANS and CRS were infrequent and evenly distributed across age groups. Tocilizumab and vasopressor use were similar across groups, indicating comparable severity. These results support Tarlatamab’s favorable safety, tolerability, and effectiveness across diverse real-world populations.