Real-world experience with tarlatamab in extensive-stage small cell lung cancer at an academic center in Mississippi.

Abstract

e20156 Background: Small cell lung cancer (SCLC) has poor outcomes, and patients from underserved rural and minority populations are underrepresented in clinical trials. Tarlatamab, a DLL3-directed bispecific T-cell engager approved in 2025 for previously treated extensive-stage SCLC, carries risks of CRS and ICANS; We report real-world safety and early outcomes in an underserved population. Methods: We conducted a retrospective chart review of patients with SCLC treated with Tarlatamab at a single academic center between May 2024 and January 2026. Data collected included demographics, geographic residence, prior therapies, treatment duration, radiographic response, survival outcomes, and treatment-related adverse events. Treatment was administered in a hospital-based outpatient setting. During cycle 1, patients were observed for 24 hours after day 1 and day 8 doses and 6–8 hours after day 15. CRS and ICANS were graded using standard criteria, including the Immune Effector Cell–Associated Encephalopathy (ICE) score. Results: Thirteen patients were identified; 12 were evaluable. Median age was 69.5 years (range, 56–80). Four patients (33%) were African American, five (41%) lived in rural counties, and nine (75%) were women. All had received ≥1 prior systemic therapy. ICANS occurred in 5 patients (50%; Grade 1, n = 2; Grade 2, n = 1; Grade 3, n = 2). CRS occurred in 5 patients (50%; Grade 1–2). All patients received dexamethasone premedication; those with ICANS required steroid escalation. Tocilizumab was given to 4 of 5 patients with CRS. No patients required ICU care; 2 required inpatient admission for Grade 2 ICANS. One patient died two weeks after cycle 1 day 15 from intracerebral seizures in the setting of progressive metastatic disease. Conclusions: In this real-world cohort from an underserved Southern state, Tarlatamab showed a manageable safety profile with meaningful representation of African American, rural, and female patients. Outpatient administration with structured monitoring was feasible, though vigilance for CRS and ICANS remains essential. These findings support broader evaluation in underrepresented populations. Remote monitoring strategies, including telemedicine and wearable devices, and expanded outreach and education for rural emergency departments, may improve early recognition and management of Tarlatamab-associated toxicities. Patient characteristics and outcomes. Parameter Value Total Patients 12 Median Age 69.5years Race Distribution African American: 4/12 (33%)White: 8/12 (67%) Median Distance from Treatment 40.85 miles (Range 12-91) ICANS Occurrence 5/12Grade 1: 2Grade 2: 1Grade 3: 2 CRS Occurrence 5/12 (Grade 1–2) ICANS Requiring Escalated Steroids 5/5 Tocilizumab for CRS 4/5 patients received one dose ICU Care Required 0/10 Required Inpatient Stay 2/12