Treatment Advances and Management of ES-SCLC

Panelists discuss how distinguishing between limited-stage and extensive-stage small cell lung cancer is essential for guiding treatment strategies, accurately staging disease, and setting appropriate expectations for prognosis and therapeutic outcomes.

Panelists discuss how the addition of immune checkpoint inhibitors to first-line chemotherapy has transformed the treatment of extensive-stage small cell lung cancer, improving survival while highlighting ongoing challenges in managing relapse and the need for continued research into novel therapies.

Panelists discuss how major unmet needs in extensive-stage small cell lung cancer—such as lack of durable responses, limited second-line options, absence of predictive biomarkers, and challenges managing brain metastases—underscore the urgency for more effective therapies and comprehensive supportive care strategies.

Panelists discuss how first-line chemoimmunotherapy has become the standard for extensive-stage small cell lung cancer (ES-SCLC) based on trials such as IMpower133 and CASPIAN, while emerging agents such as DLL3-targeted therapies show promise in the relapsed setting, highlighting the need for personalized approaches and continued clinical trial participation.

Panelists discuss how the administration of tarlatamab requires thorough pretreatment screening, staff training, and close monitoring for immune-related adverse effects such as cytokine release syndrome, emphasizing the importance of patient education, rapid intervention, and specialized infrastructure for safe and effective treatment.

Panelists discuss how optimizing tarlatamab administration requires effective multidisciplinary team collaboration, with oncology, pharmacy, neurology, and nursing coordinating on treatment plans, patient monitoring, and adverse event management to ensure consistent, comprehensive care.

Panelists discuss how tarlatamab eligibility is determined based on clinical factors such as prior treatment history, organ function, and ECOG performance status, with particular attention to how previous therapies, such as chimeric antigen receptor T-cell therapy or chemotherapy, may affect eligibility and immune system response.

Panelists discuss how tarlatamab is administered via intravenous infusion with gradual dosing increases, emphasizing the importance of immediate postinfusion monitoring for acute reactions such as cytokine release syndrome, followed by ongoing follow-up to detect delayed adverse effects and manage potential immune-related toxicities.

Panelists discuss how education materials for tarlatamab include detailed treatment overviews, potential adverse effects, and monitoring requirements, while emphasizing the importance of ensuring that patients and caregivers fully understand the information and can recognize early signs of adverse reactions.

Panelists discuss how the assessment and management of immune effector cell–associated neurotoxicity syndrome involves grading symptoms from mild to life-threatening, emphasizing the need for prompt recognition and rapid intervention to prevent progression and minimize long-term neurological damage.

Panelists discuss how recognizing and grading cytokine release syndrome (CRS) based on symptoms ranging from mild flulike effects to life-threatening conditions is essential for timely intervention, with early detection being key to managing CRS effectively and preventing progression to severe stages.

Panelists discuss how the assessment and management of immune effector cell–associated neurotoxicity syndrome involves grading symptoms from mild to life-threatening, emphasizing the need for prompt recognition and rapid intervention to prevent progression and minimize long-term neurological damage.

Panelists discuss how tarlatamab’s toxicity profile differs from traditional cytotoxic therapies, highlighting its immune-related adverse effects such as cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome, while noting its lower risk of myelosuppression and long-term organ damage compared with chemotherapy, which tends to cause cumulative toxicities such as bone marrow suppression.

Panelists discuss how standardized toxicity grading for cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome helps guide physicians in the timely management and escalation of care, emphasizing the importance of symptom grading and clear institutional protocols for intervention.

Panelists discuss how future research priorities for tarlatamab focus on optimizing administration, improving toxicity management, and enhancing patient selection, with an emphasis on minimizing adverse events while maximizing efficacy and evaluating long-term safety.

Panelists discuss how best practices for transitioning from inpatient to outpatient care involve clear communication, regular monitoring, and adjusted visit frequencies, while addressing challenges such as care coordination and patient adherence to follow-up plans.

Panelists discuss how effective management of cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome in complex extensive-stage small cell lung cancer (ES-SCLC) cases treated with tarlatamab enables patients to continue therapy and achieve meaningful clinical benefit despite early toxicities.